End effectors, surgical stapling devices, and methods of using same

ABSTRACT

An end effector for use by a surgeon to staple an anatomical structure of a patient during a minimally invasive procedure includes an anvil and a cartridge. The ends of the cartridge are coupled to the ends of the anvil. Each of the anvil and the cartridge is insertable through a trocar. The end effector is operable from outside the patient. A stapling device includes the end effector coupled to a manipulator via a shaft. The manipulator is accessible to the surgeon. The surgeon uses a clamping mechanism to selectively move the anvil and the cartridge to clamp the anatomical structure. A flexible member extends through the shaft and is coupled to at least one of the anvil and the cartridge and to the clamping mechanism. Operating the clamping mechanism withdraws the flexible member ( 46 ) from the end effector and clamps the anatomical structure between the anvil and the cartridge.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a National Stage Application under 35 U.S.C. § 371of PCT International Application No. PCT/US2015/022904 filed Mar. 27,2015, which claims the priority benefit of U.S. Provisional Patent App.No. 61/972,274 filed Mar. 29, 2014, and U.S. Provisional Patent App. No.62/046,726 filed Sep. 5, 2014, each of which is incorporated herein byreference.

TECHNICAL FIELD

The invention relates to surgical staplers, and more particularly to endeffectors and stapling devices and methods of using those devices inmedical procedures.

BACKGROUND

Surgeons have implemented surgical staplers for many years. In general,there are three main types of linear surgical staplers—open linearstaplers, open gastrointestinal anastomosis (i.e., a linear cutter), andendocutters. Staplers are often used in surgical procedures involvingthe lung, liver, and stomach and are typically used in resection of anorgan.

Surgical staplers have some common components. These include a handle,an actuator, and an end effector including a clamping mechanism. Theclamping mechanism often has a cartridge and an anvil. For thesestaplers, the surgeon clamps two members (i.e., the anvil and thecartridge) on the organ and compresses the organ between them. Oncecompressed, the surgeon uses the stapler to drive or fire staplesthrough the organ. With proper compression and alignment of the clampingmechanism, a B-shaped staple is formed. Some surgical procedures mayrequire multiple staple firings. Each firing often requires the surgeonto reload the stapler with more staples. For example, some staple linesmay require 5 to 8 reloads depending on the length and/or the staplecapacity of the stapler.

The integrity of a staple line depends on the proper formation ofB-shaped staples. This in turn depends on the stapler's capability ofcompressing tissue while, at the same time, withstanding the forcesassociated with proper B-shaped staple formation. A B-shaped staple isthe standard of care for gastrointestinal, vascular, pulmonary, andhepatic applications of surgical tissue fastening devices. Alignment ineach of the X, Y, and Z axes of the clamping mechanism with itself(e.g., alignment of the anvil with the cartridge) on each side of theorgan is necessary for proper formation of B-shaped staples.

Alignment difficulties are intensified by the trend toward minimallyinvasive surgical procedures in which the organ is remotely accessedthrough small incisions. A trocar or other cannula is inserted into eachincision and becomes the access point into the body cavity for surgicaldevices, including staplers.

Typically, the surgeon inserts at least the end effector of the staplerthrough the trocar to perform the surgical procedure. By way of example,minimally invasive surgical procedures include a laparoscopic verticalsleeve gastrectomy. Due to this restricted spacial environment,minimally invasive surgical stapling devices must be relatively smallcompared to open linear surgical staplers. Minimally invasive devicesare generally long (e.g., 35 cm to 45 cm) and thin (e.g., 5 mm to 15 mmdiameter) devices. This long and thin configuration is necessary to fitthrough the trocar into the body cavity. The limited size presents amechanical issue as B-shaped staple formation typically requires apressure of about 100 psi. Under these pressures, small, less rigid,staplers deform and so prevent proper B-shaped staple formation.

Along the same lines, current devices used in minimally invasivesurgical procedures have a fixed hinge at a proximal end. The hingeallows the anvil and cartridge to separate into a V-shapedconfiguration. Once separated, the surgeon may place the V around theorgan and then collapse the V onto the organ. As the length of the anviland cartridge increase, typically to provide a single, longer stapleline across the organ, alignment between the anvil and the cartridgebecomes more difficult, and the end effector is more difficult tomanipulate through the trocar. Poor alignment is problematic, becausewith a hinge design, the anvil and/or cartridge at the most distant endsare more likely to be displaced from an ideal alignment due todeflection associated with the forces necessary to compress the tissue.Because of this deflection, the length of current V-shaped staplers forminimally invasive procedures is limited. As a result of thislimitation, the anvil and the cartridge are limited in length.Limitations on length are problematic because this may require multiplestaple reloads. Each reload may require the surgeon to withdraw thestapler from the trocar and then reinsert and reposition the stapler onthe organ. Ultimately, these devices require more surgical time and aremore likely to fail to provide consistent B-shaped staples whenactivated.

One solution to deflection is to provide two points of connectionbetween the anvil and the cartridge instead of a single, hingedconnection. That is, the anvil and the cartridge are coupled together ateach end. However, this connection has been limited to open surgicalprocedures in which the surgeon has direct access to each end of thestapler and in which relatively large staplers may be utilized. In opensurgery, the surgeon can directly manipulate one or both of theconnections by hand. Furthermore, two-pointed connections require thatthe anvil and the cartridge extend beyond the full dimension of theorgan. This requires a large device that, while possibly appropriate foropen surgery, is not usable in minimally invasive procedures.

While current staplers are adequate, new devices and methods are neededto address the shortcomings of existing staplers and methods inminimally invasive surgical procedures. More particularly, new minimallyinvasive staplers and methods are needed that offer improvedmaneuverability and more uniform pressure application on the tissue,while providing consistent and quality resection lines created duringmedical procedures, such as during a vertical sleeve gastrectomy.

SUMMARY

An end effector for use by a surgeon to staple an anatomical structureof a patient during a minimally invasive procedure addresses these andother shortcomings and, in one embodiment, includes an anvil thatincludes a first end, a second end, and a face that is positionable on afirst side of the anatomical structure. The end effector furtherincludes a cartridge that is configured to house a plurality of staples.The cartridge has a first end, a second end, and a face that ispositionable on a second side of the anatomical structure. A flexiblemember movably couples the first end of the cartridge to the first endof the anvil, and the second end of the cartridge is movably coupled tothe second end of the anvil. Each of the anvil and the cartridge isinsertable through a trocar into the patient. The end effector isremotely operable from outside the patient with at least a portion ofone of the anvil and the cartridge being movable toward the other toclamp the end effector to the anatomical structure.

In one embodiment, the flexible member movably couples the second end ofthe anvil to the second end of the cartridge.

In one embodiment, at least one of the anvil and the cartridge slidablyreceives the flexible member when the end effector is clamped onto theanatomical structure.

In one embodiment, the anvil and the cartridge slidably receive theflexible member.

In one embodiment, the flexible member is anchored to the anvil.

In one embodiment, the flexible member is anchored to the cartridge.

In one embodiment, the end effector includes a tensioning deviceoperable by the surgeon for selectively tensioning the flexible memberto provide at least a portion of the clamping force on the anatomicalstructure. In one embodiment, the tensioning device includes a springoperably coupled to the flexible member.

In one embodiment, the first end or the second end of the cartridgeincludes a cam tube.

In one embodiment, the flexible member passes into the cam tube suchthat tensioning the flexible member pulls the anvil into the cam tube.

In one embodiment, the cam tube includes a first arcuate surface and theanvil includes a second arcuate surface that is configured to cooperatewith the first arcuate surface.

In one embodiment, the anvil includes at least one pin and the cam tubeincludes at least one channel to receive the at least one pin tofacilitate alignment between the anvil and the cartridge when the anvilenters the cam tube.

In one embodiment, the anvil includes a lever and the cam tube includesa slot to receive the lever to facilitate alignment between the anviland the cartridge when the anvil enters the cam tube.

In one embodiment, the cam tube is slidable along an axis that isgenerally parallel to the longitudinal axis of the cartridge.

In one embodiment, the cam tube includes a wedge-shaped surface and theanvil includes a tapered surface on one end thereof that engages thewedge-shaped surface when the anvil enters the cam tube.

In one embodiment, the end effector further includes a screw and the camtube is operably coupled to the screw. Rotating the screw moves the camtube along a longitudinal axis of the cartridge.

In one embodiment, when the cam tube moves along a longitudinal axis ofthe cartridge, a gap between the anvil and the cartridge changes.

In one embodiment, the flexible member extends in a non-linear path fromproximate the first end to proximate the second end of one of the anviland the cartridge.

In one embodiment, the end effector further includes a strut mechanismthat slidably cooperates with the flexible member and that includes astrut member that is coupled to one of the anvil and the cartridgebetween the first end and the second end thereof and is pivotal withrespect thereto between a disengaged position in which the strut memberis substantially parallel with the anvil and the cartridge and anengaged position in which the strut member extends transversely to theanvil and the cartridge.

In one embodiment, the manipulator includes an adjustment mechanismconfigured to adjust a gap between the anvil and the cartridge. In oneembodiment, the adjustment mechanism includes a knob and a spring inline with at least one end of the flexible member.

In one embodiment, one of the anvil and the cartridge includes at leastone alignment pin extending outwardly from the face thereof and theother of the anvil and the cartridge includes a mating recess configuredto receive the alignment pin as the anvil and cartridge are moved towardone another.

In one embodiment, the flexible member extends through the mating recessand is coupled to the alignment pin such that retraction of eachflexible member moves the alignment pin into the recess.

In one embodiment, the end effector further includes a compressionmechanism that operably couples the anvil to the cartridge, that isseparate from the flexible member, and that is configured to applycompressive force to the anatomical structure.

In one embodiment, the compression mechanism includes a hook member thatextends from the anvil, a pin that is engagable with the hook member,and a compression slide that carries the pin and is selectively slidablerelative to the cartridge. The compression mechanism is engagable whenthe hook member is positioned to engage the pin and, when thecompression slide is forcibly moved relative to the cartridge, the pinengages the hook member to compress the anatomical structure separatefrom the flexible member.

In one embodiment, the compression mechanism includes a wedge thatextends from the anvil and a collar that is engagable with the wedge andis movable relative to the cartridge. The compression mechanism isengagable when the wedge is positioned to engage the collar, and whenthe collar is moved relative to the cartridge, the wedge engages thecollar to compress the anatomical structure separate from the flexiblemember.

In one embodiment, the compression mechanism further includes a secondwedge that extends from the anvil and a cam tube that is engagable withthe second wedge and is movable relative to the cartridge. Thecompression mechanism is engagable when the second wedge is positionedto engage the cam tube, and when the cam tube is moved relative to thecartridge, the wedge engages the cam tube to compress the anatomicalstructure separate from the flexible member.

In one embodiment, at least one of the first end and the second end ofthe cartridge includes a cam tube.

In one embodiment, the first end of the cartridge includes a first camtube and the second end of the cartridge includes a second cam tube.

In one embodiment, the first and second cam tubes are configured to movealong a longitudinal axis of the cartridge, and when at least one of thefirst and second cam tubes moves, a gap between the anvil and thecartridge changes.

In one embodiment, the end effector includes an alignment mechanismconfigured to facilitate alignment between the anvil and the cartridgeas the anvil is moved toward the cartridge. In one embodiment, thealignment mechanism includes a pin on one of the anvil and the cartridgeand a recess on the other of the anvil and the cartridge.

In one embodiment, the alignment mechanism includes a knife that has afirst flange, a second flange, and a web connecting the first and secondflanges and including a cutting edge. A housing extends from thecartridge adjacent the first end, and the knife resides in the housingwhen the anvil and the cartridge are moved toward one another. A recessin the anvil is adjacent the first end of the end effector and receivesthe housing. A first slot in the anvil is open to the anvil face and tothe recess and is configured to slidably receive the web during cuttingof the anatomical structure with the cutting edge. A second slot in thecartridge is open to the cartridge face and is configured to slidablyreceive the web during cutting of the anatomical structure with thecutting edge.

In one embodiment, each of the first ends and the second ends of theanvil and the cartridge are movably coupled together by a hinge joint, aflexible member, a latch, or combinations thereof.

In one embodiment, the second end of the anvil is coupled to the secondend of the cartridge by a hinge joint, a flexible member, a latch, orcombination thereof.

In one embodiment, a hinge pivotally couples the first end of the anvilto the first end of the cartridge, and a flexible member movably couplesthe second end of the anvil to the second end of the cartridge.

In one embodiment, the end effector further includes a spring operablycoupled to each of the anvil and the cartridge and biasing the anvil andthe cartridge away from each other.

In one embodiment, one of the anvil and the cartridge further includes astud at the second end, the flexible member configured to couple to thestud.

In one embodiment, the anvil and the cartridge are coupled by a snap fitconnection at the first end.

In one embodiment, one of the anvil and the cartridge includes a hook onthe first end, the other of the anvil and the cartridge includes a leverat the first end, and the hook is configured to engage the lever tocouple the anvil and the cartridge at the first end.

In one embodiment, the end effector further includes a first flexiblemember that movably couples the first end of the anvil to the first endof the cartridge, and a second flexible member that movably couples thesecond end of the anvil to the second end of the cartridge.

In one embodiment, the first and second flexible members areindependently operable such that a clamping force between the first endsis capable of being different from a clamping force between the secondends.

In one embodiment, the first and second flexible members areindependently operable such that a gap between the first ends of theanvil and the cartridge is capable of being different from a gap betweenthe second ends of the anvil and the cartridge.

In one embodiment, the anvil and the cartridge are coupled by a latch atone of the first and second ends and a flexible member at the other ofthe first and second ends.

In one embodiment, the latch is a projection from one of the anvil andthe cartridge and the other of the anvil and the cartridge includes arecess configured to receive the latch.

In one embodiment, the latch includes a notch and the other of the anviland the cartridge further includes a pin that projects into the recessand engages the notch when the latch enters the recess.

In one embodiment, the end effector further includes a spring thatbiases the pin into engagement with the notch.

In one embodiment, the end effector further includes a release cablecoupled to the pin and operable to release the pin from the notch.

In one embodiment, the anvil and the cartridge are curved.

In one embodiment, the end effector is insertable through a trocar.

In one embodiment, an endocutter stapling device may be used by asurgeon to staple an anatomical structure of a patient during aminimally invasive surgical procedure. The endocutter stapling devicemay include the end effector, a manipulator, and a flexible member. Themanipulator is configured to be accessible to the surgeon outside of thepatient and includes a shaft coupled to the end effector and a clampingmechanism for selectively moving the anvil and the cartridge toward oneanother to clamp the anatomical structure. The flexible member extendsthrough the shaft to the end effector and is operably coupled to atleast one of the anvil and the cartridge and to the clamping mechanismsuch that operating the clamping mechanism withdraws the flexible memberfrom the end effector and clamps the anatomical structure between theanvil and the cartridge.

In one embodiment, the clamping mechanism is capable of selectivelytensioning the flexible member to clamp the anvil and the cartridge tothe anatomical structure with a first stage clamping force that permitsthe end effector to be repositioned relative to the anatomicalstructure.

In one embodiment, the first stage clamping force is between about 0.1g/mm² and about 4 g/mm².

In one embodiment, the clamping mechanism is capable of selectivelytensioning the flexible member to clamp the anvil and the cartridge tothe anatomical structure with a second stage clamping force thatsubstantially prevents the end effector from moving relative to theanatomical structure during the medical procedure.

In one embodiment, the second stage clamping force is between about 4g/mm² and about 70 g/mm².

In one embodiment, the manipulator includes a handpiece that at leastpartially houses the clamping mechanism. The clamping mechanism furtherincludes a lever that is pivotable relative to the handpiece and isoperable to activate the clamping mechanism. In one embodiment, theclamping mechanism includes a first push bar that is pivotably coupledto the lever, a second push bar that is pivotably coupled to the firstpush bar, and a pin that is coupled to the second push bar, the flexiblemember extending around the pin. Rotation of the lever relative to thehandpiece moves the pin and withdraws the flexible member from the endeffector.

In one embodiment, the clamping mechanism includes a hub that ispivotable relative to the handpiece with the lever extending from thehub, a torque arm that extends outwardly from the hub, a push bar thatis pivotably coupled to the torque arm at a first end, a clamping rodthat is pivotably coupled to the push bar at a second end and isslidably engaged with the handpiece, and two or more additional rodsthat are fixed in relation to the clamping rod with the clamping rodbetween at least two additional rods. The flexible member is in contactwith the clamping rod and with two of the additional rods such that,when the clamping mechanism is engaged, the clamping rod slides relativeto the at least two additional rods and withdraws the flexible memberfrom the end effector.

In one embodiment, the manipulator further includes a locking mechanismfor selectively locking the clamping mechanism in an engaged position inwhich the anvil and the cartridge clamp the anatomical structure.

In one embodiment, the locking mechanism includes a locking arm thatextends from the hub, a release lever that is pivotably coupled relativeto and that projects from the handpiece, and a locking finger thatextends from the release lever and is biased into engagement with thelocking arm. Rotation of the lever to engage the clamping mechanismengages the locking arm with the locking finger.

In one embodiment, the manipulator includes a stapling mechanism thathas an actuator coupled to an actuator plate that is slidable relativeto the end effector and at least one wedge coupled to the actuatorplate, wherein activating the actuator slides the actuator plate and theat least one wedge in the direction of the end effector to force thewedge into engagement with staples.

In one embodiment, the actuator is a thumb plate.

In one embodiment, the actuator is a lever and the stapling mechanismfurther includes a chain consisting of a plurality of links coupled tothe actuator plate. The lever is operably coupled to the chain such thatrotation of the lever moves the chain and the actuator plate.

In one embodiment, the manipulator includes a cutting mechanism having aknife push bar that is slidably coupled to the actuator plate and acutting edge at one end of the knife push bar. When the staplingmechanism is engaged, the actuator plate slides relative to the knifepush bar for a predetermined distance during which the knife push bar issubstantially stationary and after which the actuator plate engages theknife push bar.

In one embodiment, the wedge is engaged over the predetermined distance.

In one embodiment, the manipulator includes a cutting mechanism that isconfigured to cut the anatomical structure and is coupled to theactuator plate and, when the actuator is engaged, the stapling mechanismbegins stapling the anatomical structure prior to the cutting mechanismcutting the anatomical structure.

In one embodiment, the end effector is pivotable relative to the shaft.

In one embodiment, the device further includes an articulation mechanismthat includes a clevis and a rotation collar, the rotation collarfrictionally coupling the end effector to the clevis.

In one embodiment, the device further includes a compression mechanismthat operably couples the anvil to the cartridge, that is separate fromthe flexible member, and that is configured to apply compressive forceto the anatomical structure. The compression mechanism includes a hookmember that extends from the anvil, a pin that is engagable with thehook member, and a compression slide that carries the pin and isselectively slidable relative to the cartridge. The compressionmechanism is engagable when the hook member is positioned to engage thepin and, when the compression slide is forcibly moved relative to thecartridge, the pin engages the hook member to compress the anatomicalstructure separate from the flexible member.

In one embodiment, the device further includes a compression mechanismthat operably couples the anvil to the cartridge, that is separate fromthe flexible member, and that is configured to apply compressive forceto the anatomical structure. The compression mechanism includes a wedgethat extends from the anvil and a collar that is engagable with thewedge and is movable relative to the cartridge. The compressionmechanism is engagable when the wedge is positioned to engage thecollar, and when the collar is moved relative to the cartridge, thewedge engages the collar to compress the anatomical structure separatefrom the flexible member.

In one embodiment, a method of stapling an anatomical structure during aminimally invasive medical procedure includes inserting the end effectorthrough a trocar into a patient adjacent the anatomical structure,positioning the anvil and the cartridge on opposing sides of theanatomical structure, clamping the end effector to the anatomicalstructure at a first end and a second end of the end effector to securethe position of the end effector relative to the anatomical structure,and actuating the end effector to staple the anatomical structure.

In one embodiment, a method of stapling an anatomical structure during aminimally invasive medical procedure includes inserting the cartridge ofthe end effector through a trocar into a patient adjacent the anatomicalstructure, inserting the anvil of the end effector of claim 1 through atrocar into a patient adjacent the anatomical structure, positioning theanvil and the cartridge on opposing sides of the anatomical structure,clamping the end effector to the anatomical structure at a first end anda second end of the end effector to secure the position of the endeffector relative to the anatomical structure, and actuating the endeffector to staple the anatomical structure.

In one embodiment, an end effector for use by a surgeon to staple ananatomical structure of a patient during a minimally invasive procedure,the anatomical structure having a first side, a second side, a proximalend, and a distal end, includes an anvil that includes a first end, asecond end, and a face that is positionable on the first side of theanatomical structure. The first end of the anvil is configured to extendbeyond one of the proximal end or the distal end, and the second end ofthe anvil being configured to extend beyond the other of the proximalend or the distal end. The end effector further includes a cartridgethat is configured to house a plurality of staples and that includes afirst end, a second end, and a face that is positionable on the secondside of the anatomical structure. The first end of the cartridge isconfigured to extend beyond one of the proximal end or the distal end,and the second end of the cartridge is configured to extend beyond theother of the proximal end or the distal end. The first end of thecartridge is movably coupled to the first end of the anvil and thesecond end of the cartridge is movably coupled to the second end of theanvil. Each of the anvil and the cartridge is insertable through atrocar and the end effector is remotely operable from outside thepatient with at least a portion of one of the anvil and the cartridgebeing movable toward the other to clamp the end effector on a targetedresection line from the proximal end to the distal end of the anatomicalstructure.

In one embodiment, a method of stapling an anatomical structure during aminimally invasive medical procedure includes inserting the end effectorthrough a trocar into a patient adjacent the anatomical structure,positioning the anvil and the cartridge on opposing sides of theanatomical structure on a target resection line such that the first endof each of the anvil and the cartridge extends beyond a proximal end ofthe anatomical structure and the second end of each of the anvil and thecartridge extends beyond a distal end of the anatomical structure,clamping the end effector to the anatomical structure to secure theposition of the end effector on the resection line, and actuating theend effector only a single time to staple the anatomical structure fromthe proximal end to the distal end along the target resection line.

In one embodiment, an end effector is coupled to a manipulator having ashaft. The end effector is for use by a surgeon to staple an anatomicalstructure of a patient during a minimally invasive procedure. Theanatomical structure has a first side and a second side. The endeffector includes an anvil and a cartridge. The anvil includes a firstend, a second end, and a face that is positionable on the first side ofthe anatomical structure. The cartridge is configured to house aplurality of staples and includes a first end, a second end, and a facethat is positionable on the second side of the anatomical structure. Theend effector further includes a housing that extends from one end of theanvil or the cartridge and that includes a flange. The flange defines alongitudinal axis. The end effector further includes a clevis and arotation collar. The clevis is coupled to the shaft and is operable topivot relative to the shaft. The rotation collar is rotatably coupled tothe flange and is coupled to the clevis. The flange is capable ofrotating within the rotation collar. Each of the anvil, the cartridge,the housing, the clevis, and the rotation collar is insertable through atrocar. The end effector is rotatable about the longitudinal axis, ispivotable relative to the shaft at the clevis, and is remotely operablefrom outside the patient with at least a portion of one of the anvil andthe cartridge being movable toward the other to clamp the end effectorto the anatomical structure.

In one embodiment, the first end of the cartridge is movably coupled tothe first end of the anvil and the second end of the cartridge ismovably coupled to the second end of the anvil.

In one embodiment, the first end of the anvil is configured to extendbeyond one of a proximal end or a distal end, and the second end of theanvil is configured to extend beyond the other of the proximal end orthe distal end. The first end of the cartridge is configured to extendbeyond one of the proximal end or the distal end, and the second end ofthe cartridge is configured to extend beyond the other of the proximalend or the distal end.

In one embodiment, the end effector is for use by a surgeon to staple ananatomical structure of a patient during a minimally invasive procedure,the anatomical structure having a first side and a second side. The endeffector includes an anvil that includes a first end, a second end, anda face that is positionable on the first side of the anatomicalstructure. The end effector further includes a cartridge that isconfigured to house a plurality of staples and that includes a firstend, a second end, and a face that is positionable on the second side ofthe anatomical structure. The first end of the cartridge is separablycoupled to the first end of the anvil, and the second end of thecartridge is separably coupled to the second end of the anvil. Each ofthe anvil and the cartridge is insertable through a trocar, and the endeffector is remotely operable from outside the patient with at least aportion of one of the anvil and the cartridge being movable toward theother to clamp the end effector to the anatomical structure.

In one embodiment, the first end of the cartridge includes a first camtube and the second end of the cartridge includes a second cam tube.

In one embodiment, the first and second cam tubes are configured to movealong a longitudinal axis of the cartridge, and when at least one of thefirst and second cam tubes moves, a gap between the anvil and thecartridge changes.

In one embodiment, the first and second cam tubes are configured to movealong a longitudinal axis of the cartridge, and when at least one of thefirst and second cam tubes moves, a gap between the anvil and thecartridge changes.

In one embodiment, the anvil and the cartridge are coupled by a snap fitconnection at the first end.

In one embodiment, one of the anvil and the cartridge includes a hook onthe first end, the other of the anvil and the cartridge includes a leverat the first end, and the hook is configured to engage the lever tocouple the anvil and the cartridge at the first end.

In one embodiment, the end effector further includes a flexible memberthat couples the first end of the anvil to the first end of thecartridge.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention and,together with a general description of the invention given above, andthe detailed description given below, serve to explain the invention.

FIG. 1 depicts the anatomy of a stomach.

FIG. 2A is an elevation view of an end effector of an endocutterstapling device according to one embodiment of the invention.

FIG. 2B is an elevation view of the end effector of FIG. 2A positionedon the stomach.

FIG. 2C is an elevation view of the end effector of FIG. 2A duringresection of a portion of the stomach.

FIG. 2D is an elevation view of the end effector of FIG. 2A followingresection of a portion of the stomach.

FIG. 2E depicts the stomach anatomy resulting from an exemplary verticalsleeve gastrectomy.

FIG. 2F is an elevation view of an anvil and a cartridge for insertiononto a flexible member according to another embodiment of the invention.

FIG. 2G is an elevation view of the anvil and the cartridge shown inFIG. 2F clamped onto a stomach according to one embodiment of theinvention.

FIGS. 2H-2N are schematic views of multiple methods of assembling an endeffector according to embodiments of the invention.

FIG. 3 is a perspective view of an endocutter stapling device accordingto one embodiment of the invention.

FIG. 4 is a perspective view of the endocutter stapling device of FIG. 3with an end effector shown in an opened position.

FIG. 4A is an enlarged perspective view of the end effector shown inFIG. 4.

FIG. 5 is a disassembled perspective view of the endocutter staplingdevice of FIG. 3.

FIG. 6 is a cross-sectional view of the endocutter stapling device takenalong section line 6-6 of FIG. 4.

FIG. 6A is a cross-sectional view of the end effector shown in FIG. 6taken along section line 6A-6A.

FIG. 7 is a cross-sectional view of the endocutter stapling device takenalong section line 7-7 of FIG. 3.

FIG. 7A is a cross-sectional view of the endocutter stapling devicetaken along section line 7A-7A in FIG. 7.

FIG. 8 is an enlarged perspective view of a handpiece of the endocutterstapling device of FIG. 3.

FIG. 9 is an enlarged view of the encircled area 9 shown in FIG. 8.

FIG. 10 is a cross-sectional view of the endocutter stapling devicesimilar to that shown in FIG. 7 during stapling and cutting according toone embodiment of the invention.

FIG. 11 is an enlarged view of the encircled area 11 of the endocutterstapling device of FIG. 10.

FIG. 11A is a cross-sectional view of the endocutter stapling devicetaken along section line 11A-11A in FIG. 11.

FIG. 12 is an enlarged view of the endocutter stapling device similar toFIG. 11 during use of the endocutter stapling device.

FIG. 13 is a perspective view of a knife and a pair of wedges of theendocutter stapling device of FIG. 3.

FIG. 14 is a perspective view of the knife and the pair of wedges shownin FIG. 13 during use of the endocutter stapling device.

FIG. 15 is a perspective view of an endocutter stapling device accordingto one embodiment of the invention.

FIG. 16 is a disassembled perspective view of the endocutter staplingdevice shown in FIG. 15.

FIG. 16A is a disassembled perspective view of selected components ofthe endocutter stapling device shown in FIG. 16.

FIG. 17 is a cross-sectional perspective view of a manipulator of theendocutter stapling device shown in FIG. 15.

FIG. 18 is a cross-sectional view of the manipulator shown in FIG. 17prior to compression of one lever.

FIG. 19 is a cross-sectional view of the manipulator shown in FIG. 18following compression of one lever.

FIG. 20 is a cross-sectional view of the manipulator shown in FIG. 19following compression of a second lever.

FIGS. 21-35 are schematic views of end effectors including one or moreflexible members according to one or more embodiments of the invention.

FIG. 36 is a perspective view of an end effector shown in the openedposition according to one embodiment of the invention.

FIG. 37 is a different perspective view of the end effector shown inFIG. 36.

FIG. 38 is an enlarged cross-sectional perspective view of a proximalportion of the end effector shown in FIG. 36 shown in the closedposition.

FIG. 39 is a cross-sectional view of a distal portion of the endeffector shown in FIG. 36 with the end effector shown in the closedposition.

FIG. 40A is a perspective hidden line view of a distal portion of theend effector shown in FIG. 36 during use of the end effector.

FIG. 40B is a perspective hidden line view of the distal portion of theend effector shown in FIG. 40A after completion of a medical procedure.

FIGS. 41 and 42 are schematic elevation views of an end effectoraccording to one embodiment of the invention.

FIGS. 43 and 44 are schematic elevation views of an end effectoraccording to one embodiment of the invention.

FIGS. 45A and 45B are schematic elevation views of an end effectoraccording to one embodiment of the invention.

FIGS. 46-48 are schematic elevation views of an end effector accordingto one embodiment of the invention.

FIGS. 49 and 50 are schematic elevation views of an end effectoraccording to one embodiment of the invention.

FIG. 51 is a schematic elevation view of an end effector according toone embodiment of the invention.

FIG. 52 is a schematic elevation view of an end effector according toone embodiment of the invention.

FIG. 53 is a schematic elevation view of an end effector according toone embodiment of the invention.

FIGS. 54-56 are schematic elevation views of an end effector accordingto one embodiment of the invention.

FIGS. 57 and 58 are schematic views of an end effector according to oneembodiment of the invention.

FIGS. 59-63 are schematic elevation views of end effectors according toembodiments of the invention.

FIGS. 64 and 65 are perspective views of an end effector in a disengagedposition and an engaged position, respectively, according to oneembodiment of the invention.

FIG. 66 is a perspective view on an end effector according to oneembodiment of the invention.

FIG. 67 is a perspective view of one embodiment of an end effector.

FIGS. 68A and 68B are cross-sectional views of the end effector shown inFIG. 67 in a disengaged position and an engaged position, respectively.

FIG. 68C is a perspective view of the end effector shown in FIG. 67 inan engaged position.

FIG. 69 is a perspective view of one embodiment of an end effector in adisengaged position.

FIG. 70A is a cross-sectional view of the end effector shown in FIG. 69taken along section line 70A-70A.

FIG. 70B is a cross-sectional view of the end effector shown in FIG. 69in an engaged position.

FIG. 71 is a perspective view of one embodiment of an end effector in adisengaged position.

FIG. 72A is a cross-sectional view of the end effector shown in FIG. 71taken along section line 72A-72A.

FIG. 72B is a cross-sectional view of the end effector shown in FIG. 71in an engaged position.

DETAILED DESCRIPTION

In its broadest aspects, embodiments of the present invention aredirected to an end effector and/or an endocutter stapling device(collectively referred to as “devices” herein) for forming a resectionline during resection of an organ, tissue, or other anatomicalstructure. The devices may be used during minimally invasive surgicalprocedures. As it is described herein, one or both of the devices may beused, for example, in a vertical sleeve gastrectomy procedure. It willbe appreciated, however, that the devices may be used in otherprocedures involving other anatomical structures. For example, thedevices may be used in a parencymal resection, lung volume reductionsurgery, or other procedures involving the lung. Further, the devicesmay be useful in an anatomic resection, such as, a lobectomy, anon-anatomic parencymal resection, or other procedures involving theliver and in a partial nephrectomy, total nephrectomy, or otherprocedures involving the kidney.

To these and other ends, and with reference to the figures, FIG. 1illustrates the anatomy of the stomach 10 and a resection line 12 for avertical sleeve gastrectomy. The stomach 10 generally includes aproximal end 14, a distal end 16, an anterior side 18, and a posteriorside 20. The proximal end 14 and the distal end 16 of the stomach 10 aredescribed from the perspective of the surgeon. A gastroesophagealjunction 22 opens into the stomach 10 and is a common landmark inbariatric surgeries. A fundus 24 and the section of the stomach 10defined by a greater curvature 26 are generally the parts of the stomach10 removed during a vertical sleeve gastrectomy. The remaining pouch isgenerally defined by a lesser curvature 28 and the resection line 12 andpresents a stomach with a significantly reduced volume. The desiredlocation of the resection line 12 is about 0.5 cm to about 2 cm awayfrom the gastroesophageal junction 22 and about 2 cm to about 10 cm awayfrom a pylorus 30. In accordance with aspects of the invention,endocutter stapling devices may be utilized to form high quality,consistent resection lines during a vertical sleeve gastrectomy.Embodiments of the devices are advantageous because they are easilypositionable laparoscopically, accommodate different thicknesses oftissue along the resection line length, are capable of providingsubstantially uniform compressive pressure on the tissue along theresection line, and enable a low staple firing force.

With reference to FIG. 2A, embodiments of the present invention mayinclude a shaft 38 to which is coupled an end effector 40. The endeffector 40 has two clamping members 42, 44 coupled to one another. Asis described below in reference to FIGS. 2B-2G, the surgeon may forciblydrive the members 42, 44 toward one another to clamp an anatomicalstructure between the members 42, 44. The surgeon may close the members42, 44 remotely from the end effector 40. That is, no direct manualaccess to the end effector 40 is required. For this reason, the endeffectors, as disclosed herein, may be designed specifically for use inminimally invasive surgical procedures in which the anatomical structureor organ is accessed through a trocar. Clamping onto the anatomicalstructure permits the surgeon to be able to accurately position the endeffector 40 and ensures creation of a straight sleeve gastrectomy pouch,which is desirable. In the exemplary embodiment, and with reference toFIG. 2B, the member 42 may be an anvil generally positionable on theanterior side 18 of the stomach 10, and the member 44 may be a cartridgecoupled directly to the shaft 38 and generally positionable on theposterior side 20 of the stomach 10. As shown, the anvil 42 may besufficiently long to extend beyond each of the proximal end 14 and thedistal end 16 of the stomach 10. The cartridge 44 may also besufficiently long to extend beyond the proximal end 14 and the distalend 16 of the stomach 10. The cartridge 44 may house a plurality ofsurgical staples and a knife, each described below, for forming theresection line 12. The anvil 42 and the cartridge 44 are movably coupledtogether via a flexible member 46 and collectively operate as clampingmembers for purposes described below. While embodiment of the inventionare not limited to movably coupling the anvil 42 to the cartridge 44, asis described herein, by movably coupling the anvil 42 to the cartridge44, the anvil 42 has may directions in which it may move relative to thecartridge 44. For example, the flexible member 46 may only restrictmovement away from the cartridge 44 when the flexible member 46 isalready taut. Otherwise, the flexible member 46 may allow relativemovement in all other directions. The present invention is not limitedto the illustrated arrangement. For example, the arrangement of themembers 42, 44 may be reversed such that the anvil 42 is coupled to theshaft 38 and is positioned adjacent the posterior side 20 of the stomach10 and the cartridge 44 is coupled to the anvil 42 via the flexiblemember 46 and is positioned on the anterior side 18 of the stomach 10(not shown). Other alternative arrangements may also be possibledepending on the surgical procedure and the surgeon's preference, amongother factors.

While the flexible member 46 is shown, the anvil 42 and the cartridge 44may be coupled together at each end using a variety of engagementelements. For example, the anvil 42 and the cartridge 44 may beconfigured to connect using magnets, a clip-in connection, or othertypes of connections or connectors that are generally well known in theart. The connection method used at the proximal and distal ends of theanvil 42 and the cartridge 44 do not need to be similar. There are manyways to couple the anvil 42 and the cartridge 44 and the invention isnot limited to the flexible member shown. By way of example, many of theconnection methods described in PCT Application No. PCT/US2014/070869,which is incorporated by reference herein in its entirety, may beutilized to connect the anvil and the cartridge described herein.

In one embodiment, the surgeon may position the end effector 40proximate the stomach 10 as is shown in FIG. 2B. In this regard, FIG. 2Billustrates the end effector 40 placed around the stomach 10 on a targetresection line 12 with the anvil 42 and the cartridge 44 coupledtogether at both the proximal end 14 and the distal end 16 of thestomach 10. By way of example, the anvil 42 and the cartridge 44 may becoupled to each other with the flexible member 46 at each of theproximal end 14 and the distal end 16 of the stomach 10. The length ofthe anvil 42 and the cartridge 44 may be sufficient for the anvil 42,the cartridge 44, and the flexible member 46 to encircle the stomach 10,as shown. The length of the anvil and/or the cartridge as describedherein is not particularly limited. By way of example and notlimitation, the length of each may measure from about 35 mm to about 350mm. The end effector 40 may be put in place and used with or withouthaving to mobilize the greater curvature 26. For example, a surgeon mayprefer to leave the greater curvature 26 attached to the omentum (notshown), which could improve stability of the stomach 10 during stapling.

As is described below, the flexible member 46 may be coupled to atensioning mechanism by which the anvil 42 and the cartridge 44 may bemoved toward one another and to provide a sufficient clamping force onthe stomach 10. In addition, the flexible member 46 may be coupled to arelease mechanism that releases tension on the flexible member 46 andallows the anvil 42 to be separated from the cartridge 44, such that theend effector 40 may be repositioned prior to stapling or after formingthe resection line 12. Further, the end effector 40 may be operablycoupled to a stapling and/or cutting mechanism by which the surgeon maydrive staples and a cutting element housed in the cartridge 44, each ofwhich is described below. In one embodiment where the ends of the anvil42 and the cartridge 44 extend beyond the proximal and distal ends 14,16 of the stomach 10, the end effector 40 may be advantageouslyconfigured to complete the staple line 12 after actuating the staplingand/or cutting mechanisms only a single time. This is in contrast tocurrent procedures that require repeated activation of the staplingand/or cutting mechanisms.

In one aspect of the invention, the end effector 40 may be positionedrelative to the stomach 10 using a two-stage clamping process. In thefirst clamping stage, the anvil 42 and the cartridge 44 may be clampedonto the stomach 10 to provide a threshold amount of resistance tounintentional movement of the end effector 40 relative to the stomach10. For example, the range of clamping pressure in the first stage maybe about 0.1 g/mm² to about 4 g/mm². While preventing undesirable orunintentional movements of the end effector 40, the surgeon may move theend effector 40 to a desired position relative to the stomach 10 withoutsignificant difficulty.

In the second clamping stage, and with the end effector 40 in thedesired location relative to the stomach 10, the clamping force of theend effector 40 may be increased to effectively prevent or minimize theend effector 40 from moving relative to the stomach 10. For example, theclamping pressure in the second stage may be about 4 g/mm² to about 70g/mm². In an exemplary embodiment, the clamping pressure in the secondstage may be about 8 g/mm². The upper limit to which the end effector 40may be clamped is selected so as to avoid any damage to the underlyingtissue being clamped but also allow for adequate tissue compression forstaple formation. This upper limit may be, for example, about 70 g/mm².Additionally, the lower limit in the disclosed range of about 4 g/mm²represents a threshold clamping force below which constitutes the firststage clamping and above which constitutes the second stage clamping. Itwill be recognized that these values are merely exemplary and theparticular values may depend on several factors, including theanatomical structure being clamped. Thus, embodiments of the inventionare not limited to the range of values provided herein.

In an advantageous aspect of the invention, when the end effector 40 isplaced on the stomach 10 (e.g., in the first clamping stage as describedabove), the surgeon has a clear visualization of the intended results ofthe vertical sleeve gastrectomy prior to actually performing theresection of the stomach 10 at the resection line 12. Hence, the surgeonhas an indication of what the resultant stomach shape and volume definedby the lesser curvature 28 and the resection line 12 will likely beprior to stapling and/or cutting the stomach tissue. If the surgeon isnot satisfied with the indication of the expected stomach shape andvolume, the surgeon may adjust and manipulate the location and alignmentof the end effector 40 prior to stapling and cutting the stomach 10.This is in contrast to current procedures, where the resection line isgenerally not well visualized prior to activating the stapler, thus theultimate outcome is less certain. It will be appreciated that the endeffector 40 should be positioned such that it does not provide lateralstretching or tension of the stomach 10, which may create an undesirableenvironment for stapling and cutting. Using the end effector 40 ensuresproper alignment of the resection line 12 so that removing the fundus 24occurs at a safe distance away from both the lesser curvature 28 and thegastroesophageal junction 22. The result is a resection line 12 that issquared off at the fundus 24 of the stomach 10 to prevent or reduce thelikelihood of necrotic tissue development.

Once the end effector 40 is properly positioned, as is shown in FIG. 2B,the surgeon may then engage the tensioning mechanism, described below,to compress the anvil 42 and the cartridge 44 on the stomach 10, as isshown by the arrow 50 in FIG. 2B. In this regard, the end effector 40may be coupled to a device for tensioning the flexible member 46 to drawthe anvil 42 and the cartridge 44 onto the stomach 10. As the anvil 42and the cartridge 44 are brought together, the flexible member 46 mayalign one with the other. In this regard, the end effectors disclosedherein may be self-aligning due, in part, to coupling of the anvil 42 tothe cartridge 44 at each end. Tensioning the flexible member 46 may alsocompress the tissue. For instance, as the flexible member 46 istensioned, the distance between the anvil 42 and the cartridge 44decreases, and ultimately compresses the stomach 10. Once positioned andthe anvil 42 and the cartridge 44 are compressed, the surgeon mayactivate a cutting and stapling mechanism, described below, to cut andstaple the tissue using the end effector 40 until complete resection ofthe stomach 10 occurs, as is illustrated in the sequence of FIGS. 2C,2D, and 2E.

As noted above, the end effector 40 may be secured to the stomach 10 sothat it resists movement once the surgeon begins stapling. Asillustrated in FIGS. 2A-2E, the use of the end effector 40 aids increating an ideal gastric sleeve pouch size and shape (e.g., shown inFIG. 2E). In one embodiment, the surgeon may engage a release mechanismafter completing the resection of the stomach 10. This allows slack tobe introduced in the flexible member 46 such that the anvil 42 may beseparated from the cartridge 44. Consequently, once the anvil 42 and thecartridge 44 are separated, the end effector 40 may be removed from theabdominal cavity.

In embodiments of the present invention that include a flexible memberfor tensioning the anvil and the cartridge, the flexible member may takeseveral forms. By way of example and without limitation, the flexiblemember may include a wire, suture, thread, chain, or other elongateflexible member. The flexible member may be made of metal, plastic, orany other material that is suitable for a biological environment. Theflexible member may be, for example, a braided cable. The flexiblemember may be capable of a radius of bend of approximately 0.030 inchesand further be generally resistant to kinking, knotting, etc.Additionally, the flexible member should be able to accommodate atensile load sufficient to generate a clamping force (pressure) abovethe maximum clamping force expected to be imposed during a procedure. Byway of example, the flexible member should be able to accommodate atensile load sufficient to create a clamping force of about 70 g/mm² onthe anatomical structure. In an exemplary embodiment, the flexiblemember may be a multi-strand stainless steel cable or a polymer, such asvectran.

As illustrated in FIG. 2A, the end effector 40 may be pre-assembled andthen inserted into the abdominal cavity as a unit. In this regard, andwith reference to FIG. 2B, using standard laparoscopic instruments andgraspers, the surgeon may manipulate the end effector 40 across thestomach 10 so that the anvil 42 is generally positioned along theanterior side 18 of the stomach 10 and the cartridge 44 is generallypositioned along the posterior side 20 of the stomach 10. A distal end42 a of the anvil 42 generally extends beyond the distal end 16 of thestomach 10. A distal end 44 a of the cartridge 44 may also generallyextend beyond the distal end 16 of the stomach 10. A similarconfiguration exists at the opposite end. Proximal ends 42 b, 44 b ofthe anvil 42 and the cartridge 44, respectively, generally extend beyondthe proximal end 14 of the stomach 10. The section of the flexiblemember 46 between the anvil 42 and the cartridge 44 may loop or extendaround the distal end 16 of the stomach 10, as illustrated in FIG. 2B.The anvil 42 and the cartridge 44 may then be manipulated to provide aclamping force on the stomach 10. This clamping may be achieved bytensioning the flexible member 46, as is described below.

As an alternative to pre-assembling the end effector 40 externally, theend effector 40 may be assembled inside the abdominal cavity. In thisregard, and with reference to FIGS. 2F and 2G and in one embodiment, theflexible member 46 may be inserted through a trocar (not shown). Usinglaparoscopic instruments and graspers, the surgeon may manipulate theflexible member 46 around the stomach 10, as shown in FIG. 2F. Throughthe same or another trocar, the surgeon may then insert the member 42and/or the member 44. Each of the members 42, 44 may be engaged with theflexible member 46 and with the shaft 38. The surgeon may then performthe procedure.

Another method for partial external assembly is shown in FIGS. 2H-2K, inwhich the surgeon may use two trocars to assemble and manipulate the endeffector 40 to perform a procedure. With reference to FIG. 2H, thesurgeon may manipulate the cartridge 44 with the shaft 38 through afirst trocar 54 and insert a pair of graspers 56 through a second trocar58. The shaft 38 may be coupled to the cartridge 44 via a ball joint toaid in the proper placement of the cartridge 44. In FIG. 2I, the surgeonmay use the graspers 56 to grip a retraction tab 60 that is coupled tothe flexible member 46 and pull the retraction tab 60 and, consequently,the flexible member 46 through the second trocar 58. As is shown in FIG.2H, the retraction tab 60 extends from the cartridge 44. With referenceto FIG. 2J, the surgeon may couple the anvil 42 to the flexible member46 outside of the abdominal cavity and then slide the anvil 42 throughthe second trocar 58. The end effector 40 may initially bedisarticulated so that the surgeon may retract the flexible member 46 todraw the anvil 42 proximate the stomach 10 and then secure the flexiblemember 46 to the cartridge 44. That is, the anvil 42 may be a separablemember that is coupled to the other components such that the anvil 42 ismovably coupled to the cartridge 44, as is described above. Onceassembled, as is shown in FIG. 2K, the surgeon may perform the procedurewith the end effector 40.

With reference to FIGS. 2L and 2M, another method for assembling an endeffector is shown. In that regard, the anvil 42 may be coupled to amanipulation shaft 62, such as, by a ball joint. The manipulation shaft62 may be maneuvered through the second trocar 58 to align and movablycouple the anvil 42 to the cartridge 44. The anvil 42 may be a separablemember in this embodiment that is coupled to the other components suchthat the anvil 42 is movably coupled to the cartridge 44. By way ofexample only, the anvil 42 may be coupled to the cartridge 44 with alatch at one end and the flexible member at the other end, though otherconnection methods may be utilized. Alternative connection methods mayinclude latches at each end of the end effector or magnets that assistthe surgeon in alignment of the members 42, 44. Another alternativeconnection is shown in FIG. 2N. As shown, the members 42, 44 may becoupled together at a snap fit connection 64 a, 64 b with a ball joint66. The anvil 42 and cartridge 44 may be inserted through separatetrocars and assembled intra-abdominally. The anvil 42 may be introducedto the abdominal cavity and coupled to the cartridge 44 by an externallycontrolled instrument 62. The snap fit connection may separably couplethe anvil 42 to the cartridge, though in the absence of a flexiblemember. As yet another alternative (not shown), one of the cartridge orthe anvil may include a flexible member in the form of a loop and havinga pull tab positioned to be withdrawn from the abdominal cavity so thatthe other of the cartridge and the anvil may be coupled to the flexiblemember.

With reference to FIGS. 3-16, the surgeon may operate the end effector40 above, including one or both of the anvil 42 and the cartridge 44,during a vertical sleeve gastrectomy procedure with another mechanicaldevice that is operably coupled to the one or both of the anvil 42 andthe cartridge 44. In one embodiment, an endocutter stapling device 100includes the end effector 40 operatively coupled to a manipulator 102.As shown, the manipulator 102 includes an elongate member or shaft 104coupled to a handpiece 106 at one end and the end effector 40 at theother end thereof. During a surgical procedure, the end effector 40 anda portion of the shaft 104 may be inserted into the patient, such as viaa trocar. The surgeon may then manipulate the end effector 40 and/orarticulate the end effector 40 relative to the manipulator 102 toperform a procedure. Thus, embodiments of the present invention mayinclude mechanisms for effectuating a surgical procedure with the endeffector 40 (including clamping, stapling, and cutting tissue) and forallowing the end effector 40 to articulate relative to the shaft 104,each described below.

With reference to FIGS. 3, 4, and 4A, the anvil 42 and the cartridge 44are movably coupled together via the flexible member 46 as is describedabove. The flexible member 46 passes through hollow portions of theanvil 42 and the cartridge 44 and is movable relative to one or both ofthe anvil 42 and the cartridge 44. The flexible member 46 may beanchored to one of the anvil 42 or the cartridge 44, as is describedbelow. In the exemplary embodiment shown, the anvil 42 may be separatedfrom or brought closer to the cartridge 44 by extending or retractingthe flexible member 46. Retraction of the flexible member 46 moves theanvil 42 toward the cartridge 44 as is shown generally by arrow 52 inFIG. 4A.

In this regard, in the exemplary embodiment shown in FIGS. 4-6, theflexible member 46 extends from the shaft 104 into the cartridge 44 at aproximal end 44 b and ultimately couples the anvil 42 to the cartridge44. While numerous pathways for the flexible member 46 are describedbelow with reference to at least FIGS. 21-35, in the exemplaryembodiment, the flexible member 46 passes from the cartridge 44 and iscoupled to the anvil 42 adjacent each of a distal end 42 a and aproximal end 42 b thereof and may be anchored within the anvil 42 byanchors 110 and 112 (shown in FIG. 6).

Retraction of the flexible member 46 from the end effector 40 (and intothe manipulator 102 described below) therefore moves at least one of theanvil 42 and/or the cartridge 44 as is shown generally by the arrow 52in FIG. 6. It will be appreciated that because the flexible member 46 isanchored to the anvil 42 (e.g., proximate each of the distal end 42 aand the proximal end 42 b), retraction of the flexible member 46produces a substantially symmetrical closing force on tissue situatedbetween the anvil 42 and the cartridge 44. This configuration, withconnectivity between the anvil 42 and the cartridge 44 at each end ofthe end effector 40, is advantageous.

In this regard, in embodiments in which the anvil 42 and/or thecartridge 44 are sufficiently rigid at pressures encountered during asurgical procedure, the clamping force may be more symmetrical anduniformly distributed along the length of the anvil 42 and the cartridge44. Thus, the tissue situated between the anvil 42 and the cartridge 44may be more uniformly compressed. It will be appreciated that eventhough there may be more uniform compression on the tissue, the anvil 42and the cartridge 44 may not be parallel to one another in the clampedposition because the tissue may not be uniformly thick. Nevertheless,there may be uniformity in applied pressure. This may be unlike priorart devices in which clamping members are attached together at a single,hinge-like location and have a jaw-like motion, rather than a vice-likemotion. With a single connection, the end of the clamp member mostdistant from the connection may deflect. As a result of the deflection,the clamp member may not apply uniform, symmetrical compression to thetissue along its length. According to embodiments of the invention,producing a substantially uniformly applied clamping pressure on theorgan may enhance the formation of the resection line following staplingand cutting.

With reference to FIGS. 3, 4, 5, and 6, in one embodiment, the handpiece106 includes a main body 114 with housing halves 120 a, 120 b. Whenassembled, the housing halves 120 a, 120 b enclose control features bywhich the surgeon may operate clamping of the anvil 42 and the cartridge44 on tissue and stapling and cutting of the stomach 10. In that regard,the manipulator 102 includes a clamping mechanism 122 for applyingtension to the flexible member 46, a stapling mechanism 124 for staplingthe tissue captured between the anvil 42 and the cartridge 44, and acutting mechanism 126 for cutting the tissue. Each of these mechanismsis described below. Thus, in one aspect, the surgeon may operate theclamping mechanism 122 to control the extension and retraction of theflexible member 46 from the end effector 40. In another aspect, thesurgeon may actuate the stapling mechanism 124 to fire staples andactuate the cutting mechanism 126 to cut tissue.

To these and other ends, with continued reference to FIG. 5, themanipulator 102 includes a support 130 having a U-shaped cross-sectioncoupled to the end effector 40 at a proximal end. A guide beam 136 ofabout the same length as the support 130 reinforces the support 130 andmay include three channels 138 a, 138 b, and 140 that may receiveportions of each of the stapling mechanism 124, the cutting mechanism126, and the clamping mechanism 122. While each of these mechanisms isdescribed herein with respect to one or more embodiments, embodiments ofthe present invention may omit the cutting mechanism 126, in which case,the device may be referred to as a stapling device.

In the embodiment shown, the manipulator 102 further includes a frame150 having a shaft portion 152 and a handpiece portion 154. The shaftportion 152 may have a tubular configuration, for example, a rightcircular tubular configuration and may enclose the support 130 and theguide beam 136 when the manipulator 102 is assembled. The support 130may be configured to receive a pin 142 that cooperates with acorresponding bore 144 in the shaft portion 152 to secure the support tothe frame 150.

The handpiece portion 154 of the frame 150 includes opposing flanges 156a, 156 b defining a channel 158. Each of the flanges 156 a, 156 bincludes one or more slots that guide a portion of the clampingmechanism 122, described below. In the embodiment shown, each flange 156a, 156 b includes two pairs of slots 160 a, 160 b, 162 a, 162 b. Thepair of slots 160 a, 162 a on the flange 156 a is a mirror image of thepair of slots 160 b, 162 b on the flange 156 b. As shown, each of theslots 160 a, 160 b is elongated in a direction generally parallel withthe longitudinal axis of the manipulator 102. The slots 162 a, 162 b arealso elongated but are angled with respect to the longitudinal axis ofmanipulator 102 and angled relative to the slots 160 a, 160 b.

The clamping mechanism 122 includes a lever 170 pivotably coupledbetween the housing halves 120 a, 120 b for manipulating the flexiblemember 46. With reference to FIGS. 6 and 7, the surgeon may squeeze thelever 170 by which motion the flexible member 46 is withdrawn from theend effector 40. As is described above, withdrawing or pulling theflexible member 46 from the end effector 40 draws the anvil 42 towardthe cartridge 44 and may tension the flexible member 46 when the anvil42 and the cartridge 44 meet resistance to movement. By applying a forceto the flexible member 46, the anvil 42 and the cartridge 44 may bemoved toward one another (as is indicated by arrow 52) and may alsoapply a clamping force to tissue situated between the anvil 42 and thecartridge 44. It will be appreciated that the surgeon may operate thelever 170 with one or more fingers during operation of the endocutterstapling device 100 between a disengaged position (e.g., FIGS. 3 and 6)in which the clamping mechanism 122 does not restrict movement of theflexible member 46 and an engaged position (e.g., FIGS. 4 and 7) inwhich the clamping mechanism 122 contacts the flexible member 46.

To that end, the clamping mechanism 122 further includes a push bar 164pivotably coupled to the lever 170 by a pin 166 at one end thereof. Thepush bar 164 extends from outside the housing half 120 a, where it ispivotally attached to the lever 170 by the pin 166, into the channel 158through a slot (unlabeled) in the handpiece portion 154 of the frame150. The push bar 164 is pivotally coupled to a push bar 174 by a pin172. The pin 172 extends through the push bar 164 at one end thereofacross the channel 158 and is slidably received in each of the slots 160a, 160 b (FIG. 5). The push bar 174 is coupled to a second pin 176 atthe opposing end of the bar 174 from the pin 172. The pin 176 isslidably received in each of the slots 162 a, 162 b (FIG. 5). The pins172 and 176 interact with the flexible member 46 when the surgeonsqueezes the lever 170. By way of example only, and not limitation, oneor both of the pins 172 and 176 may be coupled to a sheave (not shown),which slidably receives the flexible member 46, to guide the flexiblemember 46 during motion of the clamping mechanism 122.

With continued reference to FIG. 6, the flexible member 46 extendsbetween the flanges 156 a, 156 b and is looped over the pin 172 and thepin 176 (e.g., in sheaves on each pin 172, 176). In the exemplaryembodiment, an additional pin 178 may extend across the channel 158 infixed relation to the frame 150. The pin 178 may be positioned at alocation that maintains the flexible member 46 in alignment with theshaft 104. In other words, the pin 178 may be configured to align theflexible member 46 with the shaft 104 independent of the position of thepins 172, 176 as the pins 172, 176 slide in relation to the slots 160 a,160 b, 162 a, 162 b. Thus, while the flexible member 46 may move inresponse to actuation of the clamping mechanism 122 along each of thepins 172, 176, the additional pin 178 may maintain alignment of theflexible member 46 with the longitudinal axis of the manipulator 102.

With reference to FIGS. 6 and 6A, depression of the clamping lever 170toward the housing half 120 a in the direction of the arrow 180 in FIG.6 may cause movement of each of the push bars 164, 174 generally awayfrom the end effector 40 in the direction of the longitudinal axis ofthe handpiece 106. Specifically, as is shown in FIG. 6, the push bars164, 174 initially have a generally L-shaped arrangement when the lever170 is extended from the handpiece 106. In this disengaged position ofthe lever 170, the anvil 42 is spaced apart from the cartridge 44, as isshown in FIGS. 6 and 6A. As the lever 170 is compressed towards thehandpiece 106 (according to the arrow 180), the push bar 164 pushes thepin 172 along the slots 160 a, 160 b (according to the arrow 184). Thismovement also simultaneously forces the push bar 174 along thelongitudinal axis of the manipulator 102 as guided by the pin 172 in theslots 162 a, 162 b (according to the arrow 186). The pins 172, 176 carrythe flexible member 46 in the same direction away from the end effector40. Overall, the flexible member 46 is withdrawn from the end effector40 resulting in movement of the anvil 42 toward the cartridge 44.

Compression of the lever 170 into the engaged position results in theconfiguration of the endocutter stapling device 100 shown in FIGS. 7 and7A, in which the push bars 164, 174 are generally aligned with respectto one another and the anvil 42 and cartridge 44 are compressed onto thestomach 10. In the generally aligned configuration between the push bars164, 174, the path around which the flexible member 46 extends islengthened relative to the L-shaped arrangement shown in FIG. 6. Bylengthening the path, the flexible member 46 is carried rearwardlywithin the handpiece 106 during actuation of lever 170. This results ina corresponding withdrawal of the flexible member 46 from the endeffector 40. Accordingly, the compression of the lever 170 toward thehousing half 120 a pulls the anvil 42 towards the cartridge 44 as isindicated by arrow 52 in FIG. 7. This motion may result in compressionof the stomach 10 between the anvil 42 and the cartridge 44, as is shownin FIG. 7A. In one embodiment, the surgeon may use a variable grippingforce on the lever 170 to effectuate the first stage of compression. Inthis regard, the surgeon may approximate a first stage gripping force onthe clamping mechanism 122 where the tissue is still slidable betweenthe anvil 42 and the cartridge 44. This is useful in positioning the endeffector around an anatomical structure, such as the stomach, where bothanterior and posterior halves of the anatomical structure must bemanaged. This is especially useful in a procedure such as a sleevegastrectomy where the surgeon desires to create the resultant stomachpouch using equal amounts of anterior and posterior stomach. By way ofexample and not limitation, the clamping mechanism 122 may be capable oftensioning the flexible member 46 to about 200 lb at each end of theanvil 42. This may provide a clamping pressure of over 100 psi.Specifically, in an exemplary embodiment, the anvil 42 and the cartridge44 may have a length of about 250 mm and a width of about 10 mmproviding a surface area of about 25 cm². With 400 lb of total tensionon the flexible member 46 (i.e., 200 lb on each side), the totalcompression pressure may be about 103 psi. At these pressures, theclamping mechanism 122 squeezes tissue fluid out of the stomach andthereby approves staple line integrity.

With reference now to FIG. 6A, in one embodiment, the anvil 42 includesa plurality of staple pockets 190 along a face 192 of the anvil 42. Thecartridge 44 includes a face 194 that opposes the face 192 of the anvil42. Each of the faces 192, 194 is configured to sandwich the stomach 10therebetween. A cartridge body 196 may at least partially enclose thecartridge 44. The staple pockets 190 in the face 192 generally align andcorrespond to a plurality of staples 198 and a plurality of stapledrivers 200 that are housed in a plurality of staple channels 206 in thecartridge 44. The staples 198 are configured to be forced through thestomach 10 and be deformed by the staple pockets 190. It will beappreciated that deforming the staples 198 into a B-shaped configurationsecures opposing sides of the stomach 10 together.

In one embodiment, to facilitate alignment between the anvil 42 and thecartridge 44, and in particular, alignment between the staples 198 andthe staple pockets 190, an alignment pin 202 may extend beyond the face192 at the distal end 42 a of the anvil 42 or the face 194 at the distalend 44 a of the cartridge 44. The other face 192, 194 of the anvil 42 orthe cartridge 44 includes a mating recess 204. Once the lever 170 iscompressed, the flexible member 46 is pulled into the handpiece 106 bythe clamping mechanism 122 as described above. This motion pulls theanvil 42 toward the cartridge 44 and the alignment pin 202 inconjunction with the recess 204 to facilitate proper alignment betweenthe anvil 42 and the cartridge 44 to align the staples 198 with acorresponding pocket 190. With reference to FIG. 7A, the anvil 42 andthe cartridge 44 are shown to compress the stomach 10 between the face192 of the anvil 42 and the face 194 of the cartridge 44 with thealignment pin 202 being received in the mating recess 204. In anotheraspect of the present invention, once the lever 170 is compressed, as isshown in FIG. 7, with the anvil 42 and the cartridge 44 compressing thestomach 10 therebetween, the surgeon may staple and cut the stomach 10along the resection line 12 (FIG. 1). To staple the stomach 10, thesurgeon activates the stapling mechanism 124.

In that regard and with reference to FIGS. 3, 8, and 9, the staplingmechanism 124 includes a staple actuator 210 having a thumb tab 212. Thestaple actuator 210 further includes an actuator plate 214 that iscoupled to the thumb tab 212. The actuator plate 214 is slidablyreceived in a slot 218 (FIG. 3) formed between the housing halves 120 a,120 b and is movable relative to the handpiece 106 as is indicated bythe arrow 232 in FIGS. 8 and 9. The actuator plate 214 includes slots222 a, 222 b spaced apart from an elongated slot 224. In the embodimentshown, the slots 222 a, 222 b each receive a wedge push bar 226 a, 226b, respectively. As is shown in FIGS. 5 and 10, the wedge push bars 226a, 226 b are elongated members that extend generally along the length ofthe handpiece 106 and through the shaft 104 and terminate proximate theend effector 40. The wedge push bars 226 a, 226 b are slidably receivedin corresponding channels 138 a, 138 b of the guide beam 136 and arepositioned to slide into engagement with the staples 198 and the stapledrivers 200 in the cartridge 44.

In one embodiment, shown in FIGS. 10 and 11, each wedge push bar 226 a,226 b terminates in a wedge tip 230 a, 230 b which, prior to activationof the stapling mechanism 124, is positioned to engage respective rowsof the staple drivers 200 in the cartridge 44. The wedge tips 230 a, 230b have a wedge-shaped configuration and, during a sliding motion throughthe end effector 40, are configured to force the staple drivers 200toward the anvil 42 and drive the corresponding staples 198 through thecompressed stomach 10 and into contact with the corresponding staplepockets 190 of the anvil 42. As shown best in FIGS. 11 and 12, the shapeof the wedge tips 230 a, 230 b forces the staples 198 into contact withthe staple pockets 190 of the anvil 42 with sufficient force to deformthe staples 198 and produce a B-shaped staple.

In one embodiment, the surgeon activates the stapling mechanism 124 bypushing the thumb tab 212 in the direction of the end effector 40 as isindicated by the arrow 232 in FIGS. 8 and 9. Pushing the thumb tab 212slides each of the wedge push bars 226 a, 226 b and the correspondingwedge tips 230 a, 230 b in the direction of the end effector 40.Specifically, and with reference now to FIGS. 10-14, pushing the thumbtab 212 (FIG. 8) moves the wedge push bars 226 a, 226 b in the directionof the arrow 234. The wedge tip 230 a engages the staple drivers 200 insequence and thereby forces the staples 198 into the correspondingstaple pockets 190 on the anvil face 192 as is indicated by the arrows238.

In another aspect of the present invention, the surgeon may cut thestomach 10 along the resection line 12 following stapling, describedabove. In one embodiment and with reference to FIG. 5, to cut thestomach 10, the surgeon activates the cutting mechanism 126. The cuttingmechanism 126 includes a knife actuator 248 including the thumb tab 212coupled to the actuator plate 214. As described above and with referenceto FIGS. 8 and 9, the actuator plate 214 is slidably received in theslot 218 formed between the housing halves 120 a, 120 b and is movablerelative to the handpiece 106 in a direction that is indicated by thearrow 232 in FIGS. 8 and 9.

With reference to FIGS. 8-14, in one embodiment, the cutting mechanism126 includes the elongated slot 224 in the actuator plate 214. A knifepush bar 250 is slidably engaged in the elongated slot 224 and may be anelongated member extending from the actuator plate 214 through thehandpiece 106 and the shaft 104 to a location adjacent the end effector40. In that regard, the knife push bar 250 is slidably received in thechannel 140 of the guide beam 136 and terminates in a cutting edge 252proximate the end effector 40 (shown best in FIGS. 11 and 12). As can beappreciated by FIGS. 5, 13, and 14, the knife push bar 250 lies inbetween the wedge push bars 226 a, 226 b.

In one embodiment, the surgeon activates the cutting mechanism 126 bypushing the thumb tab 212 in the direction of the end effector 40 as isindicated by the arrow 232 in FIGS. 8 and 10. Pushing the thumb tab 212slides the knife push bar 250 via the actuator plate 214 and pushes thecorresponding cutting edge 252 in the direction of the end effector 40.Specifically, and with reference now to FIGS. 10-12, pushing the thumbtab 212 moves the cutting edge 252 in the direction of the arrow 254(FIG. 11) along the longitudinal axis of the endocutter stapling device100. Although not shown, the cutting edge 252 cuts the stomach that maybe sandwiched between the anvil 42 and the cartridge 44.

In one embodiment, and with reference to FIGS. 8 and 9, the thumb tab212 may activate each of the stapling mechanism 124 and the cuttingmechanism 126. As is described above, the actuator plate 214 captureseach of the wedge push bars 226 a, 226 b and the knife push bar 250 inslots 222 a, 222 b and elongated slot 224, respectively. In oneembodiment, even though the actuator plate 214 is operably coupled toeach of the wedge push bars 226 a, 226 b and the knife push bar 250,engagement of the stapling mechanism 124 occurs prior to actuation ofthe cutting mechanism 126. In other words, the stapling mechanism 124engages prior to engagement of the cutting mechanism 126. The elongatedslot 224 in the actuator plate 214 is oversized relative to the portionof the knife push bar 250 that is engaged with it. This configurationresults in sliding space between the slot 224 and the knife push bar250. The knife push bar 250 therefore slides relative to the actuatorplate 214 during initial movement of the plate 214. The length of themovement of the actuator plate 214 without movement of the knife pushbar 250 is predetermined.

The elongated slot 224 is also longer than each of the slots 222 a, 222b. Because the knife push bar 250 is slidably received in the elongatedslot 224, the initial movement of the actuator plate 214 in thedirection of arrow 232 in FIG. 8 causes each of the wedge push bars 226a, 226 b to move in direct relation to the movement of the actuatorplate 214. The movement of the knife push bar 250 is however delayedrelative to the movement of the wedge push bars 226 a, 226 b. This meansthat there is a delay between activation of the stapling mechanism 124and the cutting mechanism 126. This delay is proportional to the freesliding space between the elongated slot 224 and the knife push bar 250.When the surgeon pushes the thumb tab 212 in the direction of the arrow232 in FIG. 8, the actuator plate 214 moves in the same direction andcarries the wedge push bars 226 a and 226 b with it. The knife push bar250 does not initially move. Instead, the actuator plate 214 must move apredetermined distance corresponding to the free sliding space in thedirection of the end effector 40 before the actuator plate 214 engagesthe knife push bar 250. This is shown by way of comparison between FIGS.8 and 9. In FIG. 8, the actuator plate 214 has not engaged the knifepush bar 250. In FIG. 9, the actuator plate 214 has moved a distance atleast equivalent to the free sliding space and so the actuator plate 214engages the knife push bar 250. This delay in movement between the wedgepush bars 226 a, 226 b and the knife push bar 250 results in adifference in activation time between the stapling mechanism 124 and thecutting mechanism 126. In this manner, in one embodiment, activation ofthe stapling mechanism 124 precedes activation of the cutting mechanism126.

Once the surgeon activates each of the stapling mechanism 124 and thecutting mechanism 126 by pushing on the thumb tab 212, stapling andcutting may occur substantially simultaneously. By way of example only,the stapling of the stomach 10 may precede the cutting of the stomach10. That is, after an initial delay between stapling and cutting, duringwhich the stapling mechanism 124 is activated, both of the staplingmechanism 124 and the cutting mechanism 126 are active. The surgeon maycontinue stapling and cutting the stomach 10 by continuing to push onthe thumb tab 212 until the thumb tab 212 reaches the end of its stroke.It will be appreciated that the stroke of the thumb tab 212 may begreater than the overall length of the stomach 10. Further, the strokeof the thumb tab 212 may be approximately equal to the length of the endeffector 40. At this point, the wedge tip 230 a, 230 b may be proximatethe distal end 42 a, 44 a of the end effector 40. The end effector 40and the shaft 104 may then be removed from the abdominal cavity with thestomach 10 having the configuration shown in, for example, FIG. 2E.

While embodiments of the present invention are shown and described ascutting the stomach 10, embodiments of the present invention are notlimited to those that both cut and staple the stomach. It may bepreferable to staple without cutting in some instances. Accordingly, thestaple line may be applied to the whole stomach or only a portionthereof without cutting the stomach. Resection may be performed with aseparate device, such as, with a tissue welding device (e.g., a bipolarvessel sealing and cutting device). In this situation, the end effector40 may remain clamped to the stomach 10 while the surgeon uses theseparate device. The end effector 40 may be used to guide the separatedevice during resection.

In one embodiment and with reference now to FIGS. 15-19 in which likereference numerals refer to like elements in FIGS. 3-14, the surgeon mayoperate the end effector 40 above, including one or both of the anvil 42and the cartridge 44, during a vertical sleeve gastrectomy procedurewith an endocutter stapling device 300 that includes the end effector 40operatively coupled to a manipulator 302. As shown, the manipulator 302includes an elongate member or shaft 304 coupled to a handpiece 306 atone end and the end effector 40 at the other end thereof. During asurgical procedure, the end effector 40 and a portion of the shaft 304may be inserted into an abdominal cavity of the patient, such as, via atrocar. The surgeon may then manipulate the end effector 40 and/orarticulate the end effector 40 relative to the manipulator 302 toperform a procedure. As described above, the procedure may includeclamping, stapling, and cutting a stomach or other tissue. Thus,embodiments of the present invention may include mechanisms toeffectuate a surgical procedure with the end effector 40 and may allowthe end effector 40 to articulate relative to the shaft 304.

With reference to FIGS. 15 and 16, the anvil 42 and the cartridge 44 ofthe end effector 40 are movably coupled together via the flexible member46 similar to that described above and further below. In one embodiment,the manipulator 302 includes a main body 308 having housing halves 310 aand 310 b which produce a pistol-grip like handle. When assembled, thehousing halves 310 a, 310 b enclose control features by which thesurgeon may operate the end effector 40 to perform the medicalprocedure. For example, the surgeon may open and close the anvil 42 andthe cartridge 44 and staple and/or cut the stomach 10.

In that regard, the manipulator 302 includes a clamping mechanism 320for applying tension to the flexible member 46, a stapling mechanism 322for stapling the tissue captured between the anvil 42 and the cartridge44, and a cutting mechanism 324 for cutting the tissue captured betweenthe anvil 42 and the cartridge 44. Further, the main body 308 mayinclude a locking mechanism 326 for locking the clamping mechanism 320in an engaged position. Each of these mechanisms is described below.Thus, according to one aspect, the surgeon may operate the clampingmechanism 320 to control the retraction of the flexible member 46 fromthe end effector 40 and lock the end effector 40 in an engaged position,and according to another aspect, the surgeon may actuate the staplingmechanism 322 to fire staples and actuate the cutting mechanism 324 tocut tissue, as is described below.

To those and other ends, in one embodiment and with reference to FIG.16, the manipulator 302 includes a support 330 having a U-shapedcross-sectional channel that is coupled to the end effector 40 at aproximal end. The support 330 may include a pair of bores 352 through apair of tabs at a proximal end thereof. A guide beam 332 of about thesame length as the support 330 reinforces the support 330 and mayinclude three longitudinally extending channels 336 a, 336 b, and 340that may receive portions of each of the stapling mechanism 322, thecutting mechanism 324, and the clamping mechanism 320.

The manipulator 302 further includes a frame 346 having a shaft portion348 and a handpiece portion 350. The shaft portion 348 may have atubular configuration, for example, a right circular tubularconfiguration, and may enclose the support 330 and the guide beam 332when the manipulator 302 is assembled. The shaft portion 348 may enclosethe support 330 when the manipulator 302 is assembled. The bores 352 ofthe support 330 may align with a corresponding pair of bores 354 in thehandpiece portion 350. A pin (not shown) may secure the support 330 tothe frame 346 in each of the bores 352 and 354. In the exemplaryembodiment shown, the shaft portion 348 may form the exterior surface ofthe shaft 304.

In one embodiment, the handpiece portion 350 of the frame 346 includesopposing flanges 356 a, 356 b defining a channel 358. The handpieceportion 350 may therefore have a U-shape cross-sectional configurationand is enclosed in the housing halves 310 a, 310 b. Each of the flanges356 a, 356 b includes one or more slots that guide a portion of theclamping mechanism 320, described below. In the exemplary embodimentshown, each flange 356 a, 356 b includes a slot 360 a, 360 b,respectively. As shown, each of the slots 360 a, 360 b is elongated in adirection generally parallel with the longitudinal axis of the frame346. In addition, each flange 356 a, 356 b may include a pair of throughbores 370 a, 370 b and 372 a, 372 b. As shown in FIG. 16, the bores 370a, 370 b and 372 a, 372 b are spaced apart with the corresponding slot360 a, 360 b in between the pairs of bores 370 a, 372 a and 370 b, 372b.

With reference to FIGS. 16, 17, and 18, during an operation, the surgeonmay engage the clamping mechanism 320, which withdraws the flexiblemember 46 from the end effector 40. As is described above, withdrawingor pulling the flexible member 46 from the end effector 40 draws theanvil 42 toward the cartridge 44 and tensions the flexible member 46when the anvil 42 and the cartridge 44 meet resistance to movement. Byapplying a force to the flexible member 46, the anvil 42 and thecartridge 44 may be moved toward one another (as is indicated by arrow52 in FIG. 15) and may also apply a clamping force to tissue situatedbetween the anvil 42 and the cartridge 44.

To that end, and with reference to FIG. 16-19, the clamping mechanism320 includes a lever 380 pivotally coupled between housing halves 310 a,310 b and movable between a disengage position (FIGS. 17 and 18) inwhich the anvil 42 is spaced apart from the cartridge 44 and an engagedposition (FIG. 19) in which the anvil 42 is moved toward the cartridge44 and may clamp the tissue situated between the anvil 42 and thecartridge 44. The lever 380 may be pivotally coupled within thehandpiece 306 via a hub 382, which is rotatable about a fastener 384. Atorque arm 386 extends outwardly from the hub 382 and is rotatable inthe same direction as the lever 380. For example, as is shown in FIGS.17 and 18, the lever 380 is rotatable in the counterclockwise direction(as is indicated by arrow 388), and the torque arm 386 also rotates inthe counterclockwise direction. A tab 390 extends from the hub 382 andcooperates with the stapling mechanism 322 and/or the cutting mechanism324, described below. A locking arm 398 also extends from the hub 382and is described in conjunction with the locking mechanism 326 below.

With reference to FIGS. 17 and 18, the torque arm 386 is pivotablycoupled to a push bar 392 by pin 394 at one end thereof. The push bar392 is coupled to a clamping rod 396 at the other end thereof. As shown,the clamping rod 396 is oriented generally perpendicularly to thelongitudinal axis of the shaft 304 and is slidably engaged with each ofthe slots 360 a and 360 b of the frame 346. Additional rods 400 and 402having a similar orientation as the clamping rod 396 and are positionedin the through bores 370 a, 370 b and 372 a, 372 b. As is shown best inFIG. 18, the flexible member 46 alternately weaves partway around eachof the rod 400, the clamping rod 396, and the rod 402. With thisconfiguration, the clamping rod 396 interacts with the flexible member46 when the surgeon squeezes the lever 380.

In that regard, as the surgeon squeezes the lever 380, it rotatescounterclockwise toward the main body 306, the torque arm 386 rotatescounterclockwise forcing the push bar 392 generally in the direction ofthe end effector 40 as is indicated by arrow 406. In turn, the clampingrod 396 is pushed longitudinally along the slot 360 a, 360 b whichcarries the flexible member 46 in the same direction. Because each ofthe rods 400 and 402 are stationary and the flexible member 46 is wovenaround the rods 400, 402 in the opposing direction as compared to theclamping rod 396, the path length of the flexible member 46 through therods 396, 400, and 402 is increased as the clamping rod 396 moves towardthe end effector 40. That is, squeezing the lever 380 increases the pathlength of the flexible member 46 in the manipulator 302. This increasein the path length of the flexible member 46 withdrawals the flexiblemember 46 from the end effector 40 and so retracts the anvil 42 towardthe cartridge 44.

In FIG. 19, the clamping mechanism 320 is fully engaged where the lever380 is proximate the main body 306. When the lever 380 is fullydepressed, the rod 396 may be pushed to the other end of the slots 360 aand 360 b. In other words, prior to engaging the clamping mechanism 320,the clamping rod 396 may be positioned at the end of the slots 360 a and360 b furthest from the end effector 40, and, following engagement ofthe clamping mechanism 320, the clamping rod 396 may be positioned atthe end of the slots 360 a and 360 b closest the end effector 40. Thelength of the slots 360 a, 360 b and the stroke of the torque arm 386may determine how much of the flexible member 46 is withdrawn from theend effector 40. It will be appreciated that the anvil 42 and thecartridge 44 may sufficiently compress the stomach 10 before theclamping rod 396 reaches the furthest extent of the slots 360 a and 360b. That is, less than full depression of the lever 380 may achieveclamping of the stomach 10.

Once the surgeon engages the clamping mechanism 320, the surgeon maythen engage each of the stapling mechanism 322 and the cutting mechanism324. With reference to FIGS. 18 and 19, the stapling mechanism 322 mayinclude a stapling lever 410, which is operably coupled to a staplinghub 412. The hub 412 is pivotably coupled between the housing halves 310a, 310 b via the fastener 384. The hub 412 may be adjacent the hub 382on the fastener 384. The stapling lever 410 has a U-shaped cross sectionand so surrounds the clamping lever 380 when the stapling lever 410 isfully depressed. The U-shaped cross-section of the stapling lever 410includes a stop surface 414, which is configured to engage the tab 390on the hub 382. In this regard, squeezing the lever 380 rotates the tab390 into contact with the stop surface 414. As a consequence, squeezingthe clamping lever 380 may also slightly engage the stapling mechanism322 and/or the cutting mechanism 324 as is generally shown by comparisonof FIGS. 18 and 19.

With reference to FIGS. 17-19, one or more engagement elements 416 mayproject from the hub 412 to frictionally engage a chain 418 consistingof a plurality of links 420 coupled at joints 422. Each of the links 420may be between a minimum length and a maximum length sufficient to allowthe chain 418 to bend around the hub 412 in contact with the elements416 while being capable of being forcibly pushed by the engagementelements 416 toward the end effector 40 without kinking, the reason forwhich is described below. By way of example and not limitation, eachlink 420 may be from about 20 mm to about 40 mm long.

As shown, one portion of the chain 418 may be loose or freely hangingwithin a portion of the housing halves 310 a, 310 b. Another portion ofthe chain 418 may be coupled to an actuator plate 424 proximate theshaft portion 348 of the frame 346. The actuator plate 424 may besimilar to the actuator plate 214 described with reference to FIGS. 8and 9, above. In that regard, the actuator plate 424 may include slots426 a and 426 b (shown best in FIG. 16A). Each slot 426 a, 426 bcooperates with the corresponding wedge push bar 226 a, 226 b. Theactuator plate 424 also includes an elongated slot 428 which slidablyreceives the knife push bar 250. Each of the push bars 226 a, 226 b and250 are described above with reference to the embodiment shown in FIGS.3-14.

With reference to FIGS. 19 and 20, once the clamping mechanism 320 isengaged, the surgeon may engage the stapling mechanism 322 by squeezingthe lever 410. Rotating the lever 410 in the counterclockwise directionaccording to arrow 430 also rotates the engagement elements 416counterclockwise. The engagement elements 416 therefore forcibly pushthe chain 418 and consequently the actuator plate 424 toward the endeffector 40, as is indicated by the arrow 432. In this manner, the wedgepush bars 226 a, 226 b are extended into the end effector 40 with thewedges 230 a, 230 b forcing staples through the stomach 10 as isdescribed above with reference to FIGS. 10-12.

With reference to FIG. 20, the stapling lever 410 may then be cycled ina clockwise direction as is indicated by arrow 440 while the clampinglever 380 remains compressed. Cycling the lever 410 may be required tofurther push the chain 418 toward the end effector 40 to drive thewedges 230 a, 230 b across the full length of the stomach. This mayrequire a ratcheting type motion in which the surgeon repeatedly cyclesthe lever 410 to gradually push the chain 418 toward the end effector40. In this regard, it will be appreciated that the length of the chain418 may be about equal to the length of the end effector 40 so thatcycling the lever 410 continuously drives the wedges 230 a, 230 b andthe cutting edge 252 the length of the end effector 40.

In one embodiment, once the surgeon engages the stapling mechanism 322,the surgeon may then engage the cutting mechanism 324. In the exemplaryembodiment shown, the cutting mechanism 324 shares the same structure asthe stapling mechanism 322. In particular, with reference to FIGS.18-20, the cutting mechanism 324 may include the lever 410 that drivesthe engagement elements 416, and thus the chain 418, toward the endeffector 40. The chain 418 drives the actuator plate 424, which may alsodrive the knife push bar 250. Thus, squeezing the lever 410 drives thecutting edge 252 across the length of the cartridge 44, as is describedabove in conjunction with FIGS. 8 and 9. Similar to the staplingmechanism 322, the surgeon may repeatedly cycle the lever 410 in aclockwise and counterclockwise manner to drive the cutting edge 252across the length of the cartridge 44. In the embodiment shown, cyclingthe lever 410 engages both the stapling mechanism 322 and the cuttingmechanism 324.

In one embodiment, even though the actuator plate 424 is operablycoupled to each of the wedge push bars 226 a, 226 b and the knife pushbar 250, engagement of the stapling mechanism 322 occurs prior toactuation of the cutting mechanism 324. In other words, the staplingmechanism 322 engages prior to engagement of the cutting mechanism 324.The elongated slot 428 in the actuator plate 424 is oversized relativeto the portion of the knife push bar 250 that is engaged with it. Theseconfiguration results in sliding space between the slot 428 and theknife push bar 250. The knife push bar 250 therefore slides relative tothe actuator plate 424 during initial movement of the plate 424. Thelength of the movement of the actuator plate 424 without movement of theknife push bar 250 is predetermined.

The elongated slot 428 is also longer than each of the slots 426 a, 426b. Because the knife push bar 250 is slidably received in the elongatedslot 428, the initial movement of the actuator plate 424 in thedirection of arrow 432 in FIG. 19 causes each of the wedge push bars 226a, 226 b to move in direct relation to the movement of the actuatorplate 424. The movement of the knife push bar 250 is however delayedrelative to the movement of the wedge push bars 226 a, 226 b. This meansthat there is a delay between activation of the stapling mechanism 322and the cutting mechanism 324. This delay is proportional to the freesliding space between the elongated slot 428 and the knife push bar 250.When the surgeon cycles the lever 410, the actuator plate 424 moves inthe same direction and carries the wedge push bars 226 a and 226 b withit. The knife push bar 250 does not initially move. Instead, theactuator plate 424 must move a predetermined distance corresponding tothe free sliding space in the direction of the end effector 40 beforethe actuator plate 424 engages the knife push bar 250. This delay inmovement between the wedge push bars 226 a, 226 b and the knife push bar250 results in a difference in activation time between the staplingmechanism 322 and the cutting mechanism 324. In this manner, in oneembodiment, activation of the stapling mechanism 322 precedes activationof the cutting mechanism 324.

Once the surgeon activates each of the stapling mechanism 322 and thecutting mechanism 324 by squeezing the lever 410, stapling and cuttingmay occur substantially simultaneously. By way of example only, thestapling of the stomach 10 may precede the cutting of the stomach 10.That is, after an initial delay between stapling and cutting, duringwhich the stapling mechanism 322 is activated, both of the staplingmechanism 322 and the cutting mechanism 324 are active. The surgeon maycontinue stapling and cutting the stomach 10 by cycling the lever 410until there are no more links 420 in the chain 18 available or until thewedges 230 a, 230 b reaches the end of the cartridge 44. It will beappreciated that the stroke of the stapling mechanism 322 and thecutting mechanism 324 may be greater than the overall length of thestomach 10 or may be approximately equal to the length of the endeffector 40. At this point, the wedge tips 230 a, 230 b may be proximatethe distal end 42 a, 44 a of the end effector 40. The end effector 40and the shaft 304 may then be removed from the abdominal cavity with thestomach 10 having the configuration shown in, for example, FIG. 2E.

With reference to FIGS. 16-19, in which like reference numerals refer tolike features throughout the figures, in one embodiment, the lockingmechanism 326 locks the clamping mechanism 320 in the engaged position.That is, when the surgeon engages the clamping mechanism 320 to apredetermined clamping force, the locking mechanism 326 engages. Thesurgeon may therefore then release the lever 380 and the clamping forceproduced by the clamping mechanism 320 is at least partially maintained.For example, the locking mechanism 326 may maintain a pressureequivalent to the second stage clamping pressure described above fromabout 4 g/mm² to about 70 g/mm². At these pressures, the clampingmechanism 320 squeezes tissue fluid out of the stomach and therebyapproves staple line integrity.

To that end, in one embodiment, the housing halves 310 a, 310 b enclosea portion of the locking mechanism 326. The locking mechanism 326includes a release lever 442 (shown in the form of a button) thatprojects from the housing halves 310 a, 310 b, for example, from abackside of the pistol-grip device 306. The surgeon may thereforeoperate the lever 442 with a thumb or a forefinger. The release lever442 may be pivotally mounted within the housing halves 310 a, 310 babout a fastener 452 and operably coupled to a spring (not shown)mounted on a support 446 which may bias the lever 442 in an outwardlydirection from the pistol-grip device 306. The lever 442 may include alocking finger 448 that is positioned proximate the locking arm 398. Thelocking finger 448 may be biased into engagement with the locking arm398 during manipulation of the clamping lever 380 and so automaticallyengage after a predetermined rotation of the lever 380.

With reference to FIGS. 19 and 20, during use of the endocutter staplingdevice 300, the surgeon may compress the clamping lever 380, asdescribed above. At a predetermined amount of rotation of the hub 382,the locking arm 398 slidably contacts the locking finger 448. Thelocking mechanism 326 may include structural features that permit onlyone-way rotational movement of the lever 380. By way of example only,the locking arm 398 may include a notch 450 that slidably receives thelocking finger 448. The notch 450 is configured to receive the lockingfinger 448 when the locking arm 398 rotates in the counterclockwisedirection but inhibits relative movement between the locking finger 448and the locking arm 398 in the clockwise direction. Once the surgeonreleases the clamping lever 380 with the locking finger 448 engaged inthe notch 450, the clamping lever 380 is not free to rotate in theclockwise direction. That is, the locking mechanism 326 prevents releaseof the clamping mechanism 320.

When the surgeon lets go of the clamping lever 380, the lockingmechanism 326 maintains the clamping mechanism 320 at a predeterminedengagement level. It will be appreciated that while the lockingmechanism 326 is shown to engage the clamping mechanism 320 when thelever 380 is fully compressed, embodiments of the present invention arenot limited to full compression of the clamping lever 380 for engagementof the locking mechanism 326. Rather, the position of the locking arm398 and the notch 450 relative to the locking finger 448 may be adjustedto a location at which the clamping lever 380 is only partiallydepressed before the locking finger 448 engages the notch 450. In thisregard, the surgeon may continue to compress the lever 380 such that thenotch 450 rotates past the locking finger 448. The surgeon may thenrelease the clamping lever 380 such that the locking arm 398 rotatesclockwise for a predetermined distance before the locking finger 448engages the notch 450.

Once the locking mechanism 326 is engaged by rotating the locking arm398 to a position at which the notch 450 engages or rotates past thelocking finger 448, the surgeon may release the locking mechanism 326 bypressing the lever 442. When the lever 442 is pressed, the lockingfinger 448 rotates out of interference with the notch 450 and thelocking arm 398 is free to rotate clockwise to a disengaged position.

With reference now to FIGS. 21-68, in addition to the end effector 40described above, there may be several alternative arrangements of theflexible member 46 relative to the anvil 42 and the cartridge 44 in theexemplary endocutter stapling devices 100, 300. In this regard, FIGS.21-23 are schematic illustrations of exemplary end effectors that may bealternatives to the end effector 40 described above. In the exemplaryalternative configurations, the pathway of the flexible member differsfrom the end effector 40 described above. However, in each embodiment,the flexible member(s) movably couple the anvil and the cartridge and isconfigured to be tensioned to provide a clamping force and that clampingforce is distributed between the anvil and cartridge by two points ofconnection at each end of the end effector. Each anvil may be separablefrom each cartridge so that they may be individually inserted through atrocar and then movably coupled together. Further, while a specificarrangement of anvil and cartridge may be inferred from any single oneof the figures, it is contemplated that the arrangement may be reversed.Thus, embodiments of the invention are not limited to the arrangementinferred from the figures unless otherwise stated. It will beappreciated that each of the end effectors described herein may beoperably coupled to a manipulator, such as, the manipulator 102 or 302described above with reference to FIGS. 3 and 15, or another manipulatorunless stated otherwise. The surgeon may therefore tension the flexiblemember via a manipulator.

In FIG. 21-23, an end effector 500 includes an anvil 502 and a cartridge504. The flexible member 46 has a first end 506 that is fixed to thecartridge 504 at one location. The paths by which the flexible member 46exits the end effector 500 differ between each of the FIGS. 21-23. Asecond end 508 of the flexible member 46 may be positioned outside thepatient and be pulled or otherwise manipulated by the surgeon so as toincrease the tension in the flexible member 46, and thereby generate aclamping force between the anvil 502 and the cartridge 504.

By way of example, in FIG. 21, the end 506 of the flexible member 46 isfixed to the cartridge 504 adjacent a distal end 504 a thereof, passesinto the anvil 502 at a distal end 502 a, passes along the anvil 502,out of a proximal end 502 b thereof, and into then out of a proximal end504 b of the cartridge 504. The end 508 of the flexible member 46 thenextends to one of the manipulators 102, 302 and may be manipulated asdescribed above. In FIG. 22, the end 506 of the flexible member 46 isfixed to the cartridge 504 near the proximal end 504 b and passes intothe anvil 502 near the proximal end 502 b, extends along the anvil 502,out of the distal end 502 a of the anvil 502, into the cartridge 504near the distal end 504 a, along the cartridge 504, and out of thecartridge 504 at the proximal end 504 b. The second end 508 of theflexible member 46 may be positioned outside the patient and be pulledor otherwise manipulated by the surgeon so as to increase the tension inthe flexible member 46, and thereby generate a clamping force betweenthe anvil 502 and the cartridge 504.

In FIG. 23, the end 506 of the flexible member 46 is fixed to thecartridge 504 adjacent the proximal end 504 b thereof and extends alongthe length of the cartridge 504 toward the distal end 504 a. Theflexible member 46 passes out of the cartridge 504 adjacent the distalend 504 a thereof and passes into the anvil 502 adjacent the distal end502 a thereof. The flexible member 46 extends along the length of theanvil 502 and out of the anvil 502 adjacent the proximal end 502 bthereof. The flexible member 46 then passes back into the cartridge 504adjacent the proximal end 504 b thereof and out the proximal end 504 bof cartridge 504. The second end 508 may be positioned outside thepatient and pulled or otherwise manipulated by the surgeon to increasethe tension in the flexible member 46, and thereby generate a clampingforce between the anvil 502 and the cartridge 504.

In alternative embodiments, there may be more than one flexible memberused to tension the anvil and cartridge to generate a clamping force onthe tissue. In this regard, FIGS. 24-26 are schematic illustrations ofexemplary configurations of the anvil 502 and the cartridge 504 coupledtogether via two flexible members configured to be tensioned to providea clamping force between the anvil 502 and the cartridge 504. In FIG.24, a first flexible member 510 has a first end 510 a fixed to the anvil502 adjacent the distal end 502 a thereof and passes out of the anvil502 adjacent the distal end 502 a. The first flexible member 510 thenpasses into the cartridge 504 adjacent a distal end 504 a thereof andextends along the cartridge 504 and out of the proximal end 504 b of thecartridge 504. The second end 510 b of the first flexible member 510 maybe positioned outside the patient. The arrangement further includes asecond flexible member 512 having a first end 512 a fixed to the anvil502 adjacent the proximal end 502 b thereof and passes out of the anvil502 adjacent the proximal end 502 b thereof. The second flexible member512 then passes into the cartridge 504 adjacent the proximal end 504 band passes out of the cartridge 504 at the proximal end 504 b. Thesecond end 512 b of the second flexible member 512 may be positionedoutside the patient.

With this arrangement, the second ends 510 b, 512 b may be kept separateor joined and may be pulled or otherwise manipulated by the surgeon witha manipulator, as described herein, to increase the tension in theflexible members 510, 512 and thereby generate a clamping force betweenthe anvil 502 and the cartridge 504. In one aspect, this arrangementadvantageously provides for independent control of the clamping forcesat the distal ends 502 a, 504 a and the proximal ends 502 b, 504 b ofthe end effector 500. In this regard, increasing the tension in thefirst flexible member 510 will draw the distal ends 502 a, 504 a of theanvil 502 and the cartridge 504 towards each other, as shown. As thedistance between the distal ends 502 a and 504 a decreases, the clampingforce at the distal end of the end effector 500 may increase. In asimilar manner, increasing the tension in the second flexible member 512will draw the proximal ends 502 b, 504 b of clamp members 502, 504towards each other. As the distance between the proximal ends 502 b, 504b decreases, the clamping force at the proximal end of the end effector500 may increase. The increase in tension may depend on whether theanvil 502 and the cartridge 504 encounter resistance to movement, suchas when the anvil 502 and the cartridge 504 begin compressing tissue. Inanother aspect of the exemplary embodiment shown in FIG. 24, theindependent control of the flexible members 510, 512 allows forindependent control of the gap between the anvil 502 and the cartridge504 at the distal ends 502 a, 504 a and the proximal ends 502 b, 504 bof the end effector 500.

FIG. 25 illustrates the end effector 500 according to the embodiment inFIG. 24 where the distance between the distal end 502 a of the anvil 502and the distal end 504 a of the cartridge 504 is less than the distancebetween the proximal ends 502 b, 504 b creating an overall shape of theend effector 500 that is generally trapezoidal. In other words, theanvil 502 and the cartridge 504 may be in non-parallel relation, as wasdescribed above. The gap between the anvil 502 and the cartridge 504varies from one end to the other. This non-fixed, or adjustable, gapconfiguration permits adjustment of the distance between the anvil 502and the cartridge 504 to accommodate variations in thickness of theanatomical structure, such as the stomach, as it is compressed. Thisfeature may be beneficial because it allows for different tissuethicknesses to be clamped at nearly the same clamping force bothproximally and distally and may prevent overcompression of the tissueand, as a consequence, may prevent tissue damage. By way of example, andwith reference to FIG. 1, the proximal end 14 of the stomach 10generally has a thickness less than that of the distal end 16 of thestomach 10. Accordingly, the ranges of clamping force used in thetwo-stage clamping process, as described above, may vary at the distaland proximal ends 14, 16 of the stomach 10. The end effector accordingto embodiments of the invention may permit the surgeon to vary theclamping force along the length of the stomach 10 and may aid increating an improved resection line. Further, the end effector accordingto embodiments of the invention may permit the surgeon to vary the gapbetween the anvil and the cartridge along the length of the stomach 10from parallel-gap configurations to non-parallel gap configurations.

With reference to FIG. 26, the end effector 500 includes two flexiblemembers in a side-by-side U-shaped arrangement. A first flexible member510 passes through each of the anvil 502 and the cartridge 504, and asecond flexible member 512 passes through each of the anvil 502 and thecartridge 504. Notably, the first flexible member 510 extends along eachof the anvil 502 and the cartridge 504 adjacent a first edge 520 of theanvil 502 and the second flexible member 512 extends through each of theanvil 502 and the cartridge 504 adjacent a second edge 522 of the anvil502. This arrangement advantageously provides for independent control ofthe opposing sides, as well as the ends, of the end effector 500. Inthis regard, increasing the tension in the first flexible member 510will increase the clamping force between the edges 520. In a similarmanner, increasing the tension in the second flexible member 512 willincrease the clamping force between the edges 522. This ability tocontrol the clamping force along the opposing edges 520, 522 of the endeffector 500 may be advantageous in certain applications and mayadditionally facilitate axial alignment between the anvil 502 and thecartridge 504.

With reference to FIG. 27, the end effector 500 includes two flexiblemembers in a double loop configuration. A proximal loop 526 is formedwith the first flexible member 510, which passes into the proximal end504 b of the cartridge 504 at two spaced apart locations, out of thecartridge 504 adjacent the proximal end 504 b at two spaced apartlocations, and into the anvil 502 at the proximal end 502 b at twospaced apart locations to complete the loop 526. A distal loop 528 isformed with the second flexible member 512, which passes into theproximal end 504 b of the cartridge 504 at two spaced apart locations,along the cartridge 504 at spaced apart travel paths, out of thecartridge 504 at two spaced apart locations adjacent the distal end 504a, and into the anvil 502 at the distal end 502 a at two spaced apartlocations to complete the loop 528. This configuration may provideincreased clamping force, improve alignment, and improved stabilitybetween the anvil 502 and the cartridge 504. In addition, the surgeonmay selectively control one of the proximal loop 526 and/or the distalloop 528.

With reference to FIG. 28, the end effector 500 includes a singleflexible member that is double looped. The end 506 of the flexiblemember 46 is anchored to the cartridge 504 and forms a loop 530 throughthe anvil 502, passes through the cartridge 504, forms a second loop 532through the anvil 502, and passes out of the proximal end 504 b of thecartridge 504.

In FIG. 29, the flexible members 510, 512 has an arrangement similar tothe end effector 500 shown in FIG. 24 with the addition of structuralfeatures that facilitate alignment of the anvil 502 with the cartridge504. In that regard, the anvil 502 includes an alignment pin 534adjacent the distal end 502 a and an alignment pin 536 adjacent theproximal end 502 b. The cartridge 504 includes a mating recess 538 and540 for each of the pins 534 and 536 at each end 504 a and 504 b of thecartridge 504. The flexible member 510 may pass through the alignmentpin 534 and the recess 538 and is anchored to the anvil 502. Theflexible member 512 passes through the alignment pin 536 and the recess540 and is also anchored to the anvil 502. During use, the recesses 538and 540 receive alignment pins 534, 536 and facilitate alignment betweenthe anvil 502 and the cartridge 504.

In the embodiment shown in FIGS. 30A and 30B, the flexible members 510,512 have a similar arrangement as the flexible members 510, 512 shown inFIG. 24. In addition, the anvil 502 includes a recess 542 adjacent thedistal end 502 a. The recess 542 receives a hood 544 that covers a knifeedge 546. The hood 544 may align with the recess 542 during use of theend effector 500 when the anvil 502 is retracted toward the cartridge504 (shown in FIG. 30B). The end effector 500 also includes a wedge sled548, which is pulled according to arrow 550 from the distal end towardthe proximal end of the end effector 500 to staple and cut tissue.

While the flexible members are shown to follow straight paths throughthe anvil 502 and the cartridge 504, such as through a straight hollowpassage, embodiments of the present invention are not limited tostraight paths. For example, in the embodiment shown in FIG. 31, theflexible member 46 follows a non-linear path 552 through the anvil 502.In the exemplary embodiment shown, the non-linear path 552 may betriangular or arcuate shaped, however, other configurations arepossible. This configuration may facilitate additional compression inthe middle portion of the anvil 502 and so counteract any tendency ofthe anvil 502 to bow and bulge outwardly in the middle duringcompression of the tissue.

In an exemplary embodiment that counteracts bowing of the anvil and withreference to FIGS. 32A and 32B, a non-linear path 552 may be achievedwith a strut mechanism 554, which is coupled to a guide line 556. Itwill be appreciated that the guide line 556 may extend outside thepatient and be accessible to the surgeon. The strut mechanism 554 ispivotably coupled to the anvil 502 and is rotatable about a pivot point558. In FIG. 32B, the strut mechanism 554 is activated by pulling theguide line 556 in the direction of arrow 562 (in FIG. 32A). The strutmechanism 554 pivots into position according to arrow 564 in FIG. 32Aunder the tension from the guide line 556. Once the strut mechanism 554is active, tension on the flexible member 46 substantially prevents theanvil 502 from bowing in the central portion during compression of thestomach between the anvil 502 and the cartridge 504.

In one embodiment and with reference to FIG. 33, a gap 566 between theanvil 502 and the cartridge 504 is adjustable. By way of example only,and not limitation, the gap 566, or the finishing position of the anvil502 when clamped, is adjustable by an adjustment mechanism 570, such as,by a knob (which may be located on the manipulator 102 or themanipulator 302). The surgeon may adjust the knob 570 to essentiallyreposition the flexible member 46 relative to the cartridge 504 and thuschange the gap 566. In one aspect, this arrangement advantageouslyprovides for control of the clamping force provided by the end effector500. In this regard, as the gap 566 decreases, the clamping force on theanatomical structure may increase. Adjustment of the gap 566 may includerelocation of the knob 570 along an axial direction 572 toward and awayfrom the end effector 500. This may be advantageous in that the finishposition of the anvil 502 may determine the configuration of the staple(not shown) once deformed. It will be appreciated that as the finishposition of the anvil 502 is moved toward the cartridge 504, the final,deformed configuration of the staples may change from a less thanoptimal open B-shaped to a more optimal B-shape. In this way, thesurgeon may correct the gap 566 to optimize the deformed stapleconfiguration. In this embodiment, the gap 566 may remain in a parallelconfiguration before and after adjustment.

In one embodiment and with reference to FIG. 34, there is a similar gapadjustment device to that shown in FIG. 33 and described above. Inaddition to the knob 570 for adjustment of the gap 566, the manipulator102, 302 may include a spring 574 in line with a least one end of theflexible member 46. While FIG. 34 depicts the spring 574 joining ends ofthe flexible member 46, it will be appreciated that the spring 574 maybe positioned in series with one end of the flexible member 46, and notbe connected to each end thereof. The spring 574 provides a spring forceto the flexible member 46 and thus may enable more consistentapplication of clamping pressure to the stomach. For example, the spring574 may facilitate application of from about 8 g/mm² to about 70 g/mm²of compression on the stomach. By way of example, the spring 574 mayhave a spring force of about 44 lb. By way of further example, thespring 574 may have a spring force of about 385 lb. In one exemplaryembodiment, shown in FIG. 35, the spring 574 is secured to the flexiblemember 46 in a loop configuration by a pulley 576. (By comparison, thespring 574 in FIG. 34 is in line with the flexible member 46.) Inparticular, in FIG. 35, the spring 574 is secured to a threaded nut 578at one end and the pulley 576 at the other end. The surgeon may adjustthe nut 578 to provide the optimal gap for a target closing pressurebetween the anvil 502 and the cartridge 504. The nut 578 may be lockedin position during stapling to lock in the gap during staple formation.

In one embodiment and with reference to FIGS. 36-40B, in which likereference numerals refer to like elements in FIGS. 3-20, an end effector600 has connections at the distal end and the proximal end with eachbeing of a different type. In the exemplary embodiment shown, the endeffector 600 has a hinge 602 between an anvil 604 and a cartridge 606 ata distal end 600 a of the end effector 600. The flexible member 46connects the anvil 604 and the cartridge 606 at the proximal end 600 bof the end effector 600, similar to embodiments disclose above. With thehinge 602, the anvil 604 rotates substantially in a plane between adisengaged position (shown in FIGS. 36 and 37) prior to and followingthe procedure and an engaged position when the anvil 604 is positionedto compress the stomach against the cartridge 606 (shown in FIGS. 38 and39). To rotate the anvil 604 from the disengaged position to the engagedposition, the surgeon pulls the flexible member 46 (according to arrow608) from the end effector 600. Pulling the flexible member 46 rotatesthe anvil 604 (according to arrow 610) toward the engaged, closedposition shown in FIG. 38. Tension on the flexible member 46 clampstissue between the anvil 604 and the cartridge 606 and may beresponsible for the clamping force.

In one embodiment, and with reference to FIGS. 37 and 38, the endeffector 600 includes an alignment mechanism 612 to more accuratelyalign the anvil 604 with the cartridge 606 in the closed position. Tothat end, a pin 614 guides the flexible member 46 as the surgeon pullsit from the end effector 600. As the anvil 604 approaches the engaged,closed position, the alignment mechanism 612 ensures that the anvil 604is accurately positioned relative to the cartridge 606. By way ofexample, and not limitation, alignment between the anvils andcartridges, as described herein, may mean an accuracy of plus or minus0.002 inches. Alignment between the two improves the quality of thestaple placement and deformation. The alignment mechanism 612 ispositioned at at least the proximal end 600 b of the end effector 600and may guide the anvil 604 into the closed position. To do so, thealignment mechanism 612 may engage the anvil 604 just prior to the anvil604 reaching the closed position. The last portion of the movement ofthe anvil 604 toward the cartridge 606 may be guided by the alignmentmechanism 612.

To that end, in the exemplary embodiment shown in FIGS. 36, 37, and 38,the cartridge 606 includes a frame 640 at least partially enclosing acartridge body 638 defining a face 618. The cartridge body 638 housesthe staples 198 and staple drivers 200. A slot 636 opens to the face 618and extends through the cartridge body 638 and the frame 640 to open toan outer surface of the cartridge frame 640 (shown best in FIG. 38). Theanvil 604 includes a tubular body 642 having an anvil plate 644 thatdefines an anvil face 632 and an interior surface 646. A slot 634 opensto each of the face 632 and the interior surface 646.

The alignment mechanism 612 includes a housing 616 that extendsoutwardly beyond the face 618 of the cartridge 606 (shown best in FIG.36). The housing 616 may support a knife 620, described below, having acutting edge (not shown), which performs substantially the same functionas the cutting edge 252 described above and shown, for example, in FIG.6. The alignment mechanism 612 may also include a recess 624 in theplate 644 of the anvil 604. The recess 624 is connected to the slot 634and is sized to receive the housing 616 and/or the knife 620. Withreference to FIG. 39, the knife 620 has an I-shaped configuration, muchlike an I-beam, and has a top flange 626, a bottom flange 628, and a web630 connecting the top flange 626 to the bottom flange 628. A portion ofthe web 630 that faces the distal end 600 a of the end effector 600includes the cutting edge. As shown in FIG. 38, the top flange 626 mayhave a slightly rounded configuration. When the knife 620 resides in thehousing 616, they collectively form a protrusion.

With reference to FIGS. 37 and 38, during the closing motion of theanvil 604, as the anvil 604 approaches the cartridge 606, the housing616 and the flange 626 are received in the recess 624. Thus, if theanvil 604 is not aligned with the cartridge 606 as it approaches theengaged position, the housing 616 and the top flange 626 may contact theface 632 of the anvil 604, the rounded surface of the top flange 626 mayurge realignment of the anvil 604 with the cartridge 606 so that therecess 624 may be brought into full engagement with the top flange 626in the housing 616. In this manner, the alignment mechanism 612facilitates alignment between the anvil 604 and the cartridge 606.

Once the anvil 604 is aligned with the cartridge 606, the surgeon mayengage a stapling mechanism and a cutting mechanism, each similar to thestapling mechanism 124, 322 and the cutting mechanism 126, 324 describedabove with reference to FIGS. 3-20. In that regard and with reference toFIGS. 38 and 39, the slot 634 slidably receives the web 630 of the knife620. Similarly, the slot 636 also slidably receives the web 630 of theknife 620 as the knife 620 is forced toward the distal end 600 a of theend effector 600 according to arrow 648. The flanges 626 and 628 alsoengage the anvil 604 and the cartridge 606, respectively. Specifically,the flange 626 engages the interior surface 646 of the face plate 644and the flange 628 engages the exterior surface of the frame 640. Thisconfiguration improves the rigidity of the end effector 600 duringcutting/stapling by capturing each component and preventing separationof the anvil 604 from the cartridge 606 in multiple directions. TheI-beam configuration may substantially prevent any torque produced bythe stapling/cutting action from twisting the anvil 604 relative to thecartridge 606 as can be appreciated by the cross-section shown in FIG.39 in which the knife 620 is shown to positively lock the anvil 604relative to the cartridge 606 and thereby prevent their separation aswell as prevent any significant relative side-to-side motion duringcutting/stapling.

With reference to FIGS. 40A and 40B, in one embodiment, the face plate644 includes a distal recess 652 and a distal housing 654 extends fromthe cartridge body 638. As the knife 620 is forced along the slots 634,636, it enters the housing 654 (shown in FIG. 40B) to complete staplingand/or cutting. The anvil 604 may then be rotated about the hinge 602 toa disengaged position. The recess 652 allows the knife 620 and housing654 to pass through the plate 644 as the anvil 604 is pivoted about thehinge 602.

Embodiments of the present invention are not limited to a distal hinge,as other structures may be utilized to secure and align the proximal anddistal ends of the anvil relative to the cartridge. With reference toFIGS. 41-63, in which like reference numerals refer to like featuresthrough the figures, in one embodiment of the invention, an end effector700 includes an anvil 702 and a cartridge 704, for performing forcompressing, stapling, and/or cutting a stomach. As with the endeffectors described above, the end effector 700 may be coupled to amanipulator, such as, the manipulator 102 and 302 (shown in FIGS. 3-20and described above), or another manipulator, by which the surgeon mayremotely operate the end effector 700. The anvil 702 has a face 706 andthe cartridge 704 has a face 708. During use of the end effector 700,and as is schematically shown in FIG. 42, the face 706 of the anvil 702is pulled into a position opposite the face 708 of the cartridge 704.Instead of a hinge, the cartridge 704 includes a cam tube 710 thatslidably receives the anvil 702 during a surgical procedure. The camtube 710 may be a hollowed out area within the cartridge 704 thatprojects above the face 708 of the cartridge 704. As shown, the cam tube710 includes a curved or arcuate surface 712. The anvil 702 includes anarcuate surface 714 that is configured to cooperate with the arcuatesurface 712 of the cam tube 710, as is shown in FIG. 42.

Similar to the configuration shown in FIG. 24, described above, thesurgeon may manipulate two flexible members 510, 512 that are connectedto the anvil 702 to compress a stomach or other tissue between the anvil702 and the cartridge 704. In particular, and by way of example only,the flexible member 510 is anchored to a distal end 702 a of the anvil702, passes into a distal end 704 a of the cartridge 704 through the camtube 710. From the distal end 704 a of the cartridge 704, the flexiblemember 510 passes along the length of the cartridge 704 and out of aproximal end 704 b of the cartridge 704 for manipulation by the surgeon.The flexible member 512 is anchored to a proximal end 702 b of the anvil702, passes into the cartridge 704 adjacent the proximal end 704 b ofthe cartridge 704, and passes out of the proximal end 704 b formanipulation by the surgeon.

As the surgeon tensions the flexible member 510, the anvil 702 is pulledinto the cam tube 710 (shown in FIG. 42). It will be appreciated thatthe surfaces 712, 714 may cooperate to provide a compressive forcegenerally toward the face 708 of the cartridge 704 when the surgeontensions the flexible member 510 to pull the distal end 702 a of theanvil 702 into the cam tube 710. Tensioning the flexible member 512pulls the proximal end 702 b of the anvil 702 toward the cartridge 704to compress tissue situated between the face 706 and the face 708. Oncethe anvil 702 is in position relative to the cartridge 704 or a targetcompression of the tissue is achieved as determined by the tension onone or both of the flexible members 510, 512, the surgeon may staple andcut the compressed tissue, as described above with reference to FIGS.3-20. It will be appreciated that the configuration of the cartridge 704shown in FIG. 41 may require the surgeon to tension the flexible member510 first to guide the distal end 702 a into the cam tube 710. Thesurgeon may then tension the flexible member 512 to bring the anvil 702into the position shown in FIG. 42.

With continued reference to FIGS. 41 and 42, in one embodiment, theanvil 702 includes anvil pins 718, and the cartridge 704 includeschannels 720 that are configured to receive the anvil pins 718. Asshown, the anvil pin 718 is disposed proximate the distal end 702 a ofthe anvil 702 and projects outwardly from the outer surface of the anvil702. The channels 720 are disposed proximate the distal end 704 a of thecartridge 704 within the cam tube 710. As shown, the channel 720 is opentoward the proximal end 704 b of the cartridge 704 and is angled in adirection toward the face 708 of the cartridge 704. The channel 720terminates proximate the distal end 704 a of the cartridge 704 nearer tothe face 708 than the opening of the channel 720. While not shown inFIGS. 41 and 42, it will be appreciated that an anvil pin may bedisposed on each of the right and left sides of the anvil 702.Similarly, the cartridge 704 may include channels disposed inside thecam tube 710 on either side to receive the anvil pins.

During use of the end effector 700 shown in FIGS. 41 and 42, tensioningthe flexible member 510 pulls the anvil 702 within the cartridge 704 toengage the surfaces 712, 714. This motion is also engages the anvil pin718 within the channel 720. Further tensioning the flexible member 510produces a compressive force generally in the direction of the face 708of the cartridge 704 due to the engagement between one or both of thesurfaces 712, 714 and the anvil pin 718 with the channel 720.Advantageously, in addition to the above, the anvil pin 718 and channel720 facilitates alignment between the anvil 702 and the cartridge 704.

With reference now to FIGS. 43 and 44, in which like reference numeralsrefer to like features of FIGS. 41 and 42, in one embodiment of theinvention, the anvil 702 includes an anvil lever 724 positioned on thesurface 714 proximate the distal end 702 a. The cartridge 704 includes aslot 726 configured to receive the anvil lever 724 as the cartridge 704is drawn into the cam tube 710. Advantageously, the combination of theanvil lever 724 and the slot 726 aligns the anvil 702 with the cartridge704. This alignment ensures that the staple channels (described above)are adjacent to the corresponding staple pockets (described above) onthe anvil 702. In addition, as is shown in FIGS. 43 and 44, a singleflexible member 46 may be anchored to the cartridge 704 proximate theproximal end 704 b similar to the configuration shown in FIG. 22 anddescribed above.

In one embodiment of the invention and with reference to FIGS. 45A and45B, in which like reference numerals refer to like features of FIGS.21-42, the end effector 700 includes a distal hinge 730 coupling thedistal end 702 a of the anvil 702 with the distal end 704 a of thecartridge 704. The hinge 730 may provide alignment between the anvil 702and the cartridge 704 in at least two directions with respect to theface 708 of the cartridge 704. The anvil 702 may further include a latch732 projecting from the face 706 proximate the proximal end 702 b of theanvil 702. The cartridge 704 may include a recess 734 and is configuredto receive the latch 732 when the anvil 702 is brought to be engagedposition. As shown, the latch 732 may include a notch 736. The cartridge704 may house a pin 738 that projects into the recess 734 and that maybe biased in one direction by a spring 740.

The anvil 702 may be rotated about the hinge 730 to an engaged positionwith tissue situated between the face 706 of the anvil 702 and the face708 of the cartridge 704. Guided by the hinge 730 the surgeon may rotatethe anvil 702 by pulling on the flexible member 46 through the cartridge704. In the exemplary embodiment, the flexible member 46 is anchored tothe latch 732 and passes through the recess 734. With reference to FIG.45B, the latch 732 may enter the recess 734 to engage the pin 738, whichenters the notch 736 under the bias of the spring 740. Thus, in thisembodiment, each of the proximal end and the distal end of the endeffector 700 is positively locked with respect to at least outwardmovement of the anvil 702 relative to the cartridge 704. In view of theabove, the latch 732 may align the anvil 702 with the cartridge 704 andmaintain that alignment against forces that tend to push the anvil 702an outward direction relative to the face 708.

Following stapling and/or cutting, the surgeon may withdraw the pin 738from the notch 736 by pulling a release cable 742. The anvil 702 maythen be rotated to an opened or disengaged position. In one embodiment,the end effector 700 further includes a release spring 744 (shown inFIG. 45B) that is coupled to each of the anvil 702 and the cartridge704. In the exemplary embodiment shown, the cartridge 704 houses therelease spring 744. When the anvil 702 is in the engaged position withthe latch 732 and the recess 734, the release spring 744 is biased in adirection to push the anvil 702 away from the cartridge 704. That is,the release spring 744 is biased to disengage the anvil 702 from thecartridge 704 when the anvil 702 is in the engaged position. Thus, inthis embodiment, when the surgeon pulls on the release cable 742, therelease spring 744 acts to push apart or separate the anvil 702 from thecartridge 704. In this way, the release spring 744 assists the surgeonin opening the end effector 700.

In one embodiment, and with reference to FIGS. 46-48, in which likereference numerals refer to like features of FIGS. 21-45B, the anvil 702is coupled to the cartridge 704 by the distal hinge 730. The flexiblemember 46 passes through the cartridge 704 at the proximal end 704 b andis anchored to the anvil 702 at the proximal end 702 b. As with theembodiment shown in FIGS. 45A-45B, the surgeon may rotate the anvil 702to the engaged position by tensioning the flexible member 46. In thisway, the anvil 702 rotates about the hinge 730 toward the cartridge 704as is indicated by arrow 748 in FIG. 46. With reference to FIG. 46, theanvil 702 includes a tapered surface 750 at the proximal end 702 b thatforms a wedge-like configuration at the proximal end 702 b of the anvil702.

The end effector 700 further includes a proximal cam tube 752 that ismovable relative to the cartridge 704 according to the arrow 754 in FIG.47. The cam tube 752 includes a cavity 756 that faces the proximal end702 b of the anvil 702 when the anvil 702 is in an engaged position. Thecavity 756 includes a wedge surface 760 that is positioned to engage thetapered surface 750 of the anvil 702. After the surgeon pulls theflexible member 46 to engage the anvil 702 with the tissue between theanvil 702 and the cartridge 704, the surgeon may force the cam tube 752toward the proximal end 702 b as is indicated by arrow 754. As thesurgeon does so, the wedge surface 760 engages the tapered surface 750.The forcible contact between the two surfaces 750 and 760 forces theanvil 702 toward the cartridge 704. Thus, in this embodiment, each end702 a, 702 b of the anvil 702 is captured to substantially preventseparation of the anvil 702 from the tissue. Pressure on the tissue maybe increased by the forced engagement of the tapered surface 750 and thewedge surface 760.

In one embodiment, and with reference to FIGS. 49 and 50, in which likereference numerals refer to like features of FIGS. 41-48, the endeffector 700 combines various features of end effectors shown anddescribed above. In that regard, the end effector 700 combines thedistal cam tube 710 and the proximal latch 732. The surgeon maytherefore withdraw the flexible member 510 to pull the anvil 702 intothe distal cam tube 710 as is indicated by the arrow 762. Once insertedtherein, the surgeon may withdraw the flexible member 512 to pull thelatch 732 into the recess 734 with the pin 738 engaging the notch 736,as is shown in FIG. 50.

In one embodiment, and with reference to FIG. 51, in which like numeralsrefer to like features in FIGS. 41-50, the end effector 700 includes adistal latch 764 similar to the proximal latch 732 described above. Thedistal latch 764 on the anvil 702 fits within a recess 766 on thecartridge 704. While the latch 764 is shown to be part of the anvil 702,it will be appreciated that the latch 764 may be a part of the cartridge704. That is, the orientation may be reversed from that shown in FIG. 51or in any of the figures described above. As shown, the flexible member46 passes through the cartridge 704, out of the distal end 704 a, intothe distal end 702 a of the anvil 702, out of the proximal end 702 b ofthe anvil 702, and into the proximal end 704 b of the cartridge 704where it is anchored to the cartridge 704. The surgeon may withdrawalthe flexible member 46 to move the anvil 702 toward the cartridge 704.Withdrawing the flexible member 46 pulls the distal latch 764 into therecess 766. Each of the distal end 702 a and the proximal end 702 b ofthe anvil 702 is secured to the cartridge 704. The latch 764 may bereleased by pulling the release cable 742.

In one embodiment and with reference to FIG. 52, in which like referencenumerals refer to like features in FIGS. 41-51, the end effector 700includes latches at each of the ends 702 a, 702 b of the anvil 702. Inthat regard, the end effector 700 includes the proximal latch 732 andthe distal latch 767. The surgeon may withdrawal the flexible member 46to pull the anvil 702 toward the cartridge 704. Pulling the flexiblemember 46 pulls each of the latches 732, 767 into the correspondingrecess 734, 766 to secure each of the ends 702 a, 702 b of the anvil 702to the cartridge 704. The surgeon may pull the release cables 742 torelease the anvil 702 from the cartridge 704. The release cables 742 maybe separate or may be linked within the end effector 700 or anotherportion of the device.

In one embodiment and with reference to FIG. 53, in which like referencenumerals refer to like features in FIGS. 51-52, the end effector 700includes a distal latch 764 and a proximal cam tube 752. When thesurgeon pulls the flexible member 46, the distal latch 764 enters therecess 766 and the pin 738 engages the notch 736 to secure the distalend 702 a of the anvil 702 to the cartridge 704. Once the anvil 702 isproximate the cartridge 704, the surgeon may push the proximal cam tube752 into engagement with the proximal end 702 b of the anvil 702. Thewedge surface 760 may engage a corresponding tapered surface 750 on theanvil 702. As described above, forcing the wedge surface 760 intocontact with the anvil 702 produces a force in the direction of thecartridge 704 and secures the proximal end 702 b to the anvil 702 to thecartridge 704. The surgeon may release the anvil 702 by pulling therelease cable 742 to disengage the latch 764 at the distal end 702 a ofthe anvil 702 and pulling the proximal cam tube 752 to disengage theproximal end 702 b of the anvil 702.

In one embodiment and with reference to FIGS. 54-56, in which likereference numerals refer to like features throughout FIGS. 41-53, theend effector 700 may include a knife 770 having a cutting edge 772 and awedge sled 774. The knife 770 may have an I-beam cross-sectionalconfiguration similar to that shown in FIG. 39 and described above. Theknife 770 is received in a channel 776 in the cartridge 704 and in achannel 778 in the anvil 702 when the anvil 702 compresses tissuebetween the anvil 702 and the cartridge 704. The flexible member 46 maypass through the cartridge 704 in the channel 776, through the knife 770in the channel 778 to the proximal end 702 b of the anvil 702, out ofthe proximal end 702 b, and into the proximal end 704 b of the cartridge704 where it is anchored. The surgeon may pull on the flexible member 46to draw the anvil 702 toward the cartridge 704.

With reference to FIG. 55, doing so pulls the knife 770 into the channel778 and aligns the anvil 702 with the cartridge 704 at the distal ends702 a, 704 a. At the proximal ends 702 b, 704 b, the surgeon may pushthe proximal cam tube 752 into engagement with the proximal end 702 b ofthe anvil 702, as is described above, to secure and align the proximalends 702 b, 704 b. Once secured and aligned, as is shown in FIG. 56, thesurgeon may continue to pull the flexible member 46. Pulling theflexible member 46 draws the knife 770 along each channel 776, 778 tostaple and cut tissue which is described above with reference to FIGS.30A and 30B.

In one embodiment and with reference to FIGS. 57 and 58, in which likereference numerals refer to like elements in FIGS. 41-56, the endeffector 700 includes the distal cam tube 710 and the proximal cam tube752. Each of the anvil 702 and the cartridge 704 are separably coupledtogether by the cam tubes 710 and 752. In this regard, the surgeon maymove the anvil 702 and the cartridge 704 independently of each other.Once positioned proximate the other, at least one of the cam tubes 710and 752 is movable relative to the other along a screw 782 operable bythe surgeon, for example, with a knob 784 to movably couple the anvil702 to the cartridge 704. In the embodiment shown, the cam tube 752 ismovable relative to cam tube 710. Rotating the knob 784 in one directiondraws the cam tube 752 toward the other cam tube 710, and rotating theknob 784 in the opposite direction pushes the cam tube 752 away from thecam tube 710. In addition to capturing and aligning the anvil 702relative to the cartridge 704, the surgeon may control the gap betweenthe cam tubes 710, 752 by rotating the knob 784 to predeterminedpositions at which the gap between the anvil 702 and the cartridge 704is known. In this regard, the gap may be varied by the amount ofengagement between one or both of the cam tubes 710, 752 and the anvil702. By moving both cam tubes 710, 752, the surgeon may control the gapbetween the anvil 702 and the cartridge 704 in a parallel configuration.By moving one of the cam tubes 710, 752, the surgeon may control the gapbetween the anvil 702 and the cartridge 704 in a non-parallelconfiguration. Further, this arrangement advantageously provides forcontrol of the clamping force provided by the end effector 700. In thisregard, as the gap between the anvil 702 and the cartridge 704decreases, the clamping force on the anatomical structure may increase.

In one embodiment and with reference to FIG. 59, in which like referencenumerals refer to like elements of FIGS. 41-58, the end effector 700includes the proximal latch 732 with two flexible members 510 and 512.The flexible member 510 passes through the cartridge 704, out of thedistal end 704 a, and into the anvil 702 proximate the distal end 702 awhere it is anchored to the anvil 702. The flexible member 512 passesthrough the cartridge 704, out of the proximal end 704 b through therecess 734, and may be anchored to the latch 732. Pulling each of theflexible members 510, 512 draws the anvil 702 toward the cartridge 704with the latch 732 entering the recess 734. The pin 738 engages thenotch 736 under the influence of the bias produced by the spring 740 toalign and secure the anvil 702 against movement away from the cartridge704. Once the surgical procedure is complete, to release the anvil 702,the surgeon may pull the release cable 742 allowing the pin 738 todisengage from the latch 732. Releasing each of the flexible members510, 512 permits the anvil 702 to be moved apart from the cartridge 704.

In one embodiment, and with reference now to FIG. 60, in which likereference numerals refer to like features of FIGS. 41-59, the endeffector 700 includes a single flexible member 46 having a pathwaysimilar to that shown in FIG. 51, for example. The flexible member 46 isanchored proximate the proximate end 704 b of the cartridge 704. Thefunction of the end effector 700 shown in FIG. 60 may be somewhat likethat shown in FIG. 59 with movement of the anvil 702 being achieved bypulling the flexible member 46. The anvil 702 may be released by pullingthe release cable 742.

In one embodiment, and with reference to FIG. 61, in which likereference numerals refer to like features of FIGS. 41-60, the endeffector 700 includes a proximal hinge 790 to pivotally secure the anvil702 to the cartridge 704. The flexible member 46 passes along the lengthof the cartridge 704, exits the distal end 704 a of the cartridge 704,and may be anchored to the distal end 702 a of the anvil 702. Thesurgeon may withdraw the flexible member 46 from the end effector 700 torotate the distal end 702 a toward the distal end 704 a of the cartridge704. The proximal hinge 790 ensures alignment between the anvil 702 andthe cartridge 704 at the proximal ends 702 b, 704 b thereof and alsosecures the anvil 702 to the cartridge 704. In one embodiment, and withreference to FIG. 62, in which like reference numerals refer to likefeatures of FIGS. 41-61, the end effector 700 is similar to the endeffector 700 shown in FIG. 61, but with the distal latch 764 describedabove with reference to FIG. 51. In this embodiment, the surgeon maypull the flexible member 46 to pivot the anvil 702 about the hinge 790.The latch 764 may enter the recess 766 with the pin 738 engaging thenotch 736 to align and secure the anvil 702 to the cartridge 704 at thedistal end 702 a, 704 a. The hinge 790 secures the anvil 702 to thecartridge 704 at the proximal end 702 b, 704 b. The surgeon may releasethe distal end 702 a from the cartridge 704 by pulling on the releasecable 742.

In one embodiment, and with reference to FIG. 63, in which likereference numerals refer to like features of FIGS. 41-62, the endeffector 700 includes the proximal hinge 790 but is secured at thedistal end 702 a, 704 a by the flexible member 46. In particular, theflexible member 46 passes through the cartridge 704 and exits the distalend 704 a and is configured with a loop 46 a. The anvil 702 includes astud 794 that projects from the distal end 702 a. Although not shown,the loop 46 a may be coupled to the stud 794. The surgeon may withdrawthe flexible member 46 from the end effector 700 to rotate the anvil 702toward the cartridge 704. The hinge 790 secures the anvil 702 to thecartridge 704 at the proximal end 702 b, 704 b and the loop 46 a securesthe anvil 702 to the cartridge 704 at the distal end 702 a, 704 a.

In one embodiment, and with reference to FIGS. 64 and 65, in which likereference numerals refer to like features throughout the drawings, theend effector 800 includes an anvil 802 and a cartridge 804. As with theend effectors described above, the end effector 800 may be coupled to amanipulator, such as, the manipulator 102 and 302 (shown in FIGS. 3-20and described above), or another manipulator, by which the surgeon mayremotely operate the end effector 800. In FIG. 64, a distal end 802 a ofthe anvil 802 is shown as having a hook 806. A distal end 804 a of thecartridge 804 has a lever 808. As the surgeon pulls the flexible member46, the distal end 802 a is pulled beneath the lever 808 as is shownFIG. 65. In particular, the hook 806 engages the lever 808 to align andsecure the anvil 802 to the cartridge 804.

With reference to FIG. 66, in which like reference numerals refer tolike features throughout the drawings, an end effector 820 includes acurved anvil 822 having a first end 822 a and a second end 822 b and acurved cartridge 824 having a first end 824 a and a second end 824 b.The anvil 822 and the cartridge 824 are shaped to fit together with thefirst ends 822 a, 824 a and second ends 822 b, 824 b in alignment whenthe anvil 822 aligns with the cartridge 824. The cartridge 824 includesa first cam tube 828 and a second cam tube 830. A flexible member 826movably couples the anvil 822 with the cartridge 824. The surgeonwithdraws the flexible member 826 from the end effector 820. Doing sodraws the anvil 822 and cartridge 824 together with the first end 822 aof the anvil 822 entering the distal cam tube 828. This configuration issimilar to the distal cam tube 710 disclosed above with reference toFIG. 41, for example. To secure the second ends 822 b, 824 b, thesurgeon pushes the proximal cam tube 830 to engage the anvil 822.Proximal cam tubes are shown in at least FIGS. 46-48 described above.

In one embodiment, and with reference to FIGS. 67-68C, in which likereference numerals refer to like features throughout the drawings, anend effector 900 is capable of clamping tissue. The end effector 900 iscoupled to a shaft 910, which may be any of shafts 104, 304, describedabove, or another shaft that is operatively coupled to a manipulator.The end effector 900 is capable of articulating relative to the shaft910 in one or more directions. The end effector 900 includes an anvil902 and a cartridge 904 coupled together at a distal end 906 thereof bya hinge 908. In particular, the hinge 908 couples distal ends 902 a, 904a of the anvil 902 and cartridge 904, respectively, together. A flexiblemember 912 is operatively coupled to a proximal end 902 b of the anvil902 and couples the proximal end 902 b to the cartridge 904. By way ofexample only, and not limitation, as is shown in FIG. 68A, an anchor 914secured to an end of the flexible member 912 resides within anundersized bore 916 and couples the flexible member 912 to the anvil902. The flexible member 912 passes through the shaft 910 and may beaccessible to the surgeon. Similar to previous embodiments, the surgeonmay withdraw the flexible member 912 from the end effector 900 to rotatethe anvil 902 about the hinge 908 toward the cartridge 904 as isindicated by arrow 920 in FIGS. 67 and 68A.

In addition, the end effector 900 may further include a compressionmechanism 930 by which additional compressive force may be applied tothe tissue situated between the anvil 902 and the cartridge 904. In theembodiment shown in FIGS. 67-68B, the compression mechanism 930 includesa hook member 932 that extends from the proximal end 902 b of the anvil902. The hook member 932 defines a slot 934. As shown in FIG. 68A, theslot 934 opens toward the cartridge 904 and is angled relative to alongitudinal axis 936 of the anvil 902. By way of example only, the slot934 is angled from about 25° to less than about 90° from thelongitudinal axis 936.

The compression mechanism 930 may also include a compression housing 938that extends from a proximal end 904 b of the cartridge 904 and couplesthe end effector 900 to the remainder of the medical device (not shown)via the shaft 910. The compression housing 938 includes two spaced-apartflanges 940 a, 940 b defining a channel 942 between them. As shown, theflexible member 912 passes through the compression housing 938. In theexemplary embodiment shown, the flexible member 912 passes through thechannel 942. Each of the flanges 940 a, 940 b defines a slot 948 a, 948b, respectively, that generally extends parallel to the longitudinalaxis of the cartridge 904. A rotation flange 946 (FIG. 68A) defines oneend of the housing 938 and extends generally radially outwardly relativeto the spaced-apart flanges 940 a, 940 b and is described below. Acompression slide 950 is slidable relative to the compression housing938 in a direction defined by the channel 942. The compression slide 950carries a compression pin 954 that is slidably received in the slots 948a, 948 b of the compression housing 938. As is shown best in FIG. 68A, acompression cable 956 is coupled to the compression slide 950 andextends through the shaft 910 and may be accessible to the surgeon.

During a surgical procedure, the surgeon may withdraw the flexiblemember 912 from the end effector 900. Doing so rotates the anvil 902toward the cartridge 904 and clamps tissue between the anvil 902 and thecartridge 904. The anvil 902 approaches the cartridge 904 with the hook932 entering the channel 944 of the compression housing 938. It will beappreciated that additional tension on the flexible member 912 may beinsufficient to further compress the tissue between the anvil 902 andthe cartridge 904. If so, the surgeon may engage the compressionmechanism 930 to apply additional pressure to the tissue. In thatregard, the surgeon may retract the compression cable 956 from the endeffector 900.

With reference to FIG. 68B, as the surgeon retracts the compressioncable 956, the compression slide 950 is forced toward the shaft 910according to arrow 958. Sliding movement of the compression slide 950 inthe channel 944 forces the pin 954 into the slot 934. Because the slot934 is angled relative to the longitudinal axis 936 (FIG. 68A), forcingthe compression slide 950 and the pin 954 in the direction indicated byarrow 958 produces a clamping force in the direction of the cartridge904. This force pulls the anvil 902 toward the cartridge 904 and soprovides additional compression of the tissue.

In one embodiment, and with reference now to FIG. 68C, according to oneaspect of the invention, the end effector 900 may be articulatedrelative to the shaft 910. An articulation mechanism 970 may providethis motion (indicated by arrows 964 in FIG. 68C). With reference toFIGS. 67 and 68C, in one embodiment, the articulation mechanism 970includes a clevis 972 that is secured to the end effector 900 at one endand the shaft 910 at the other end by pins 974. A portion of the clevis972 is coupled to the shaft 910 at a pair of cutouts 978 at one end ofthe shaft 910. The pin 974 provides a pivot point about which the shaftmay rotate relative to the end effector 900. In addition, the clevis 972is coupled to a rotation collar 976 by another pin 974. The rotationcollar 976 surrounds at least a portion of each of the clevis 972 andthe rotation flange 946 of the compression housing 938. The rotationcollar 976 thus frictionally couples the end effector 900 to the clevis972 and may define a longitudinal axis 980 about which the end effector900 may be rotatable. Embodiments of the present invention may thereforebe configured to rotate about an axis nearest the end effector and pivotabout an axis nearest the shaft. That is, according to embodiments ofthe invention, there may be an ordered arrangement between the rotationand the pivoting motion, as shown. While it may be possible for the endeffector 900 to rotate relative to the clevis 972 within the rotationcollar 976, rotation of the shaft 910 may also rotate the end effector900 via frictional engagement between the clevis 972 and the rotationcollar 976.

During a surgical procedure, the surgeon may desire to rotate the shaft910 relative to the end effector 900. Relative movement between theshaft 910 and the compression housing 938 is permitted by a combinationof the clevis 972 and the rotation collar 976. The clevis 972 allowsbending between the end effector 900 and the shaft 910 (as indicated byarrow 968 in FIG. 68C), and the collar 976 allows rotation around thelongitudinal axis of the end effector 900 (as is indicated by arrows 964in FIG. 68C) by allowing relative movement between the clevis 972 andthe compression housing 938. It will be appreciated that when thesurgeon pulls the compression cable 956, the compression housing 938 maybe forced against the clevis 972. This additional applied pressure maysubstantially prevent relative rotation between the housing 938 and theclevis 972 and so essentially locks the orientation of the end effector900 relative to the shaft 910.

In one embodiment, and with reference to FIGS. 69-70B, in which likereference numerals refer to like features of FIGS. 67-68B, an endeffector 1000 is capable of clamping tissue. The end effector 1000 iscoupled to the shaft 910 by the clevis 972 and is capable ofarticulating relative to the shaft 910. To those ends, the end effector1000 includes an anvil 1002 pivotally coupled to a cartridge 1004 at ahinge 1006 at a distal end 1008 thereof. The flexible member 912 couplesthe anvil 1002 to the cartridge 1004 at a proximal end 1010 thereof andis assessable to the surgeon. As with the embodiment shown in FIGS.67-68B and described above, the surgeon may withdraw the flexible member912 from the end effector 1000 to clamp tissue between the anvil 1002and the cartridge 1004. However, the clamping pressure achievable withthe flexible member 912 may be insufficient. To provide additionalclamping, the end effector 1000 may include a compression mechanism 1020capable of applying additional pressure to the tissue situated betweenthe anvil 1002 and the cartridge 1004.

In that regard, the compression mechanism 1020 may include a compressionwedge 1022 extending from the proximal end 1002 b of the anvil 1002. Thecompression wedge 1022 may have a dogleg-like configuration and soproject from the proximal end 1002 b of the anvil 1002 at an angle. Withreference to FIG. 70A, the compression wedge 1022 includes a wedgesurface 1024 that is oriented at a transverse angle relative to alongitudinal axis 1028 of the anvil 1002. The wedge surface 1024 isangled relative to the longitudinal axis 1028 of the anvil 1002. By wayof example only, the surface 1024 is angled from about 10° to about 60°from the longitudinal axis 1028, and by way of further example, thesurface 1024 may be angled from about 10° to about 45° or from about 20°to about 30° from the longitudinal axis 1028. It will be appreciatedthat the steeper the angle, the shorter the clamping stroke and thehigher the clamping forces that have to be supplied. The reverse mayalso be true. That is, the shallower the angle, the longer the clampingstroke and the lower the clamping forces that have to be supplied.

The compression mechanism 1020 may also include a compression housing1030 extending from the proximal end 1004 b of the cartridge 1004. Asshown best in FIG. 69, the compression housing 1030 includes opposingflanges 1032 a, 1032 b that define a channel 1034, which is configuredto receive at least a portion of the compression wedge 1022 as the anvil1002 clamps tissue between the anvil 1002 and the cartridge 1004. As isshown in FIGS. 69 and 70B, a routing pin 1036 is coupled to each of theflanges 1032 a, 1032 b and spans the channel 1034. The flexible member912 is slidably coupled to the pin 1036 and so the pin 1036 guides theflexible member 912 through the channel 1034 and into the shaft 910.

With reference to FIGS. 70A and 70B, the compression housing 1030further includes a radially extending flange 1040 that defines theproximal end of the compression housing 1030. The radially extendingflange 1040 defines a through bore 1042 through which passes theflexible member 912. An attachment pin 1044 is coupled to the flange1040 and spans the through bore 1042. A compression cable 1048 iscoupled to the attachment pin 1044 and extends through the shaft and maybe accessible by the surgeon. A rotation collar 1050 slidably couplesthe compression housing 1030 to the shaft 910 (e.g., by the clevis 972).The rotation collar 1050 has a partially closed end 1052, which providesan interference fit with the flange 1040 and functions as a stop todistal movement of the compression housing 1030 within the flange 1040.The rotation collar 1050 may define the longitudinal axis 980 aboutwhich the surgeon may rotate the end effector 1000.

As is shown best in FIG. 70A, the rotation collar 1050 is an elongatedtubular body with an overall length that exceeds the correspondinglength dimension of the flange 1040 of the compression housing 1030.Accordingly, when the anvil 1002 is in the disengaged position, as isshown in FIG. 70A, the flange 1040 is positioned adjacent the partiallyclosed end 1052 within the rotation collar 1050. In view of the relativedifference in lengths of the flange 1040 and the collar 1050, a gap 1054exists between the flange 1040 and the clevis 972 into which the flange1040 may slide as the surgeon engages the compression mechanism 1020 asis described below.

With reference to FIGS. 70A and 70B, the surgeon may engage thecompression mechanism 1020 by pulling on the compression cable 1048.After the anvil 1002 is clamped onto tissue between the anvil 1002 andthe cartridge 1004, at least a portion of the compression wedge 1022 mayreside between the flanges 1032 a, 1032 b in the channel 1034. To applyadditional compression to the tissue, the surgeon may pull thecompression cable 1048 from the end effector 1000. The applied forcecauses relative movement between the rotation collar 1050 and the flange1040. Specifically, pulling on the compression cable 1048 pulls theflange 1040 in the proximal direction into the gap 1054. This drives thepartially closed end 1052 of the rotation collar 1050 into contact withthe wedge surface 1024 (shown in FIG. 70B). Because of the angledorientation of the wedge surface 1024, the partially closed end 1052 ofthe rotation collar 1050 forces the anvil 1002 toward the cartridge 1004and accordingly applies additional pressure to the tissue situatedtherebetween. By this motion, a gap 1056 may be formed between theflange 1040 adjacent the partially closed end 1052 of the flange 1040when the anvil 1002 is in an engaged position and the compressionmechanism 1020 is engaged. As the gap 1056 increases, the gap 1054 isreduced.

In another aspect of the exemplary embodiment shown in FIGS. 69-70B, thesurgeon may articulate the end effector 1000 relative to the shaft 910.As with the embodiment shown in FIG. 67, the shaft 910 may be coupled tothe end effector 1000 by the clevis 972. The rotation collar 1050captures a portion of the clevis 972 adjacent the flange 1040. Theclevis 972 is configured to provide pivotal motion between the endeffector 1000 and the shaft 910 at a pivot point defined by one of thepins 974.

In addition, and with reference to FIGS. 70A and 70B, the articulationmechanism 970 further includes a rotation tube 1058. As shown, therotation tube 1058 passes through the clevis 972 and the shaft 910 andmay be operable by the surgeon. The rotation tube 1058 defines anelongated through bore 1060 that extends axially through the length ofthe rotation tube 1058. The rotation tube 1058 may be a hollow flexibleshaft. The compression cable 1048 may run axially from the end effector1000 through the shaft 910 within the through bore 1060. By way ofexample only and not limitation, the rotation tube 1058 may befabricated from a series of tightly wound wires of multiple layers witheach layer being wound opposite directions from at least one adjacentlayer. It will be appreciated that the rotation tube 1058 allows powertransmission around a bend, such as, through the clevis 972 when it isbent. In one embodiment, the rotation tube 1058 is secured to the flange1040 such that rotation of the rotation tube 1058 rotates the endeffector 1000 about the longitudinal axis 980.

With continued reference to FIGS. 70A and 70B, in one embodiment, thearticulation mechanism 970 includes an articulation cable 1062 that iscoupled to the clevis 972. The articulation cable 1062 extends from theclevis 972 through the shaft 910 to a location accessible by thesurgeon. The surgeon may pull the articulation cable 1062 to cause theend effector 1000 to articulate about the pin 974 that couples theclevis 972 to the shaft 910. Advantageously, the surgeon may control thedegree to which the shaft 910 is angled with respect to the end effector1000.

In one embodiment and with reference now to FIGS. 71-72B, in which likereference numerals refer to like features of FIG. 67-70B, the endeffector 1100 includes an anvil 1102 coupled to a cartridge 1104 byflexible members 1106 and 1108 at proximal and distal ends 1110, 1112 ofthe end effector 1100, respectively. As with previous embodiments, theend effector 1100 is configured to clamp tissue between the anvil 1102and the cartridge 1104 and is configured to articulate relative to theshaft 910. In that regard, the end effector 1100 includes a compressionmechanism 1120 and an articulation mechanism 1130 pivotally couples theend effector 1100 to the shaft 910.

With reference to FIG. 72A, in one embodiment, the flexible members 1106and 1108 are anchored to the anvil 1102 by anchors 914, described abovewith reference to FIG. 68A. The flexible members 1106, 1108 pass intoand through the cartridge 1104 at corresponding ends thereof and throughthe shaft 910 and may be accessible to the surgeon. In this regard, thesurgeon may withdraw each of the flexible members 1106, 1108 from theend effector 1100 to pull the anvil 1102 toward the cartridge 1104, asis indicated by arrow 1132 in FIG. 72A. It will be appreciated that thesurgeon may be unable to compress tissue between the anvil 1102 and thecartridge 1104 sufficiently by tensioning the flexible members 1106,1108. The surgeon may then engage the compression mechanism 1120 toprovide additional compression of the tissue.

Referring to FIG. 71, in one embodiment, the compression mechanism 1120includes a distal clamping mechanism 1134 at the distal end 1112 of theend effector 1100 and a proximal clamping mechanism 1136 at the proximalend 1110 of the end effector 1100. The compression mechanism 1120differs from the compression mechanism 1020 in that additionalcompressive forces may be applied to each and of the anvil 1102. Thesurgeon may therefore engage each of the clamping mechanisms 1134, 1136to further compress the tissue between the anvil 1102 and the cartridge1104. Advantageously, the clamping mechanisms 1134, 1136 may providemore uniform compression at each end 1110, 1112 of the end effector1100.

With continued reference to FIG. 71, each of the clamping mechanisms1134, 1136 includes a compression wedge 1138, 1140, similar to thecompression wedge 1022 described above with reference to FIG. 69, andwhich have a dog-leg like configuration including a wedge surface 1142and 1144, respectively. As is shown best in FIG. 72A, each of thesurfaces 1142, 1144 is oriented at an angle relative to a longitudinalaxis 1148 of the anvil 1102. The angles may be within the same rangeidentified above with reference to FIG. 70A and the wedge surface 1024.

The clamping mechanism 1134 includes a distal cam tube 1150 that ismovable relative to the cartridge 1104 on a slide 1152. The cam tube1150 has a cavity 1154 that is sized to receive the compression wedge1138. The clamping mechanism 1136 further includes the compressionhousing 1030 (described above with respect to FIG. 69) at the proximalend 1110 that is configured to receive the compression wedge 1140between the flanges 1032 a, 1032 b in the channel 1034. A rotationcollar 1160 (similar to the rotation collar 1050 described above withreference to FIG. 69) captures the flange 1040 on the compressionhousing 1030. As described above, the compression cable 1048 is coupledto the compression housing 1030 by attachment pin 1044.

During a surgical procedure, the surgeon may withdraw each of theflexible members 1106, 1108 from the end effector 1100. Doing so pullsthe anvil 1102 toward the cartridge 1104 to compress the tissuetherebetween. As set forth above, the surgeon may be unable to applysufficient compressive pressure to sufficiently collapse the tissuebetween the anvil 1102 and the cartridge 1104 with the flexible members1106, 1108 alone. The surgeon may apply additional compressive pressureby engaging the compression mechanism 1120, including each of the distalclamping mechanism 1134 and the proximal clamping mechanism 1136.

To do so, and with reference to FIGS. 72A and 72B, when the anvil 1102is proximate the cartridge 1104 in a position in which the compressionwedges 1138, 1140 are positioned to be engaged by the distal cam tube1150 and the rotation collar 1160, respectively, the surgeon may tensionthe compression cable 1048 to forcibly engage the wedge surface 1144 ofthe compression wedge 1140 with the rotation collar 1160. At theproximal end 1110, tensioning the compression cable 1048 pulls thecompression housing 1030 within the rotation collar 1160 and engages therotation collar 1160 with the wedge surface 1144. Forcible engagementbetween the wedge surface 1144 and the rotation collar 1160 forces theanvil 1102 toward the cartridge 1104. At the distal end 1112, tensioningthe compression cable 1048 pulls the cam tube 1150 toward thecompression wedge 1138 to forcibly engage the cam tube 1150 with thewedge surface 1142. Forcible engagement between the wedge surface 1142and the cam tube 1150 forces the anvil 1102 toward the cartridge 1104.In this way, additional compressive pressures may be applied at each endof the end effector 1100. In the exemplary embodiment shown, thearticulation mechanism 1130 may be substantially similar to thearticulation mechanism 970 described above with reference to FIG.69-70B.

While the present invention has been illustrated by a description ofvarious preferred embodiments and while these embodiments have beendescribed in some detail, it is not the intention of the inventor torestrict or in any way limit the scope of the appended claims to suchdetail. Though the embodiments described herein were primarily directedto a resection line guide, it is clear that many of the aspects of thepresent invention may be utilized with additional devices. By way ofexample, the embodiments described herein may operate as a surgicalclamp or a stabilizing device independent of the aspects of the presentinvention that allow the embodiments to act as an endocutter staplingdevice or a component thereof. Additional advantages and modificationswill readily appear to those skilled in the art. The various features ofthe invention may be used alone or in any combination depending on theneeds and preferences of the user.

What is claimed is:
 1. An end effector for use by a surgeon to staple ananatomical structure of a patient during a minimally invasive procedure,the anatomical structure having a first side and a second side, the endeffector comprising: an anvil that includes a first end, a second end,and a face that is positionable on the first side of the anatomicalstructure; a cartridge that is configured to house a plurality ofstaples and that includes a first end, a second end, and a face that ispositionable on the second side of the anatomical structure; and aflexible member that movably couples the first end of the anvil to thefirst end of the cartridge, wherein the anvil and the cartridge slidablyreceive the flexible member; wherein the second end of the anvil ismovably coupled to the second end of the cartridge, each of the anviland the cartridge is insertable through a trocar and the end effector isremotely operable from outside the patient with at least a portion ofone of the anvil and the cartridge being movable toward the other toclamp the end effector to the anatomical structure.
 2. The end effectorof claim 1, wherein at least one of the first end and the second end ofthe cartridge includes a cam tube, wherein the flexible member passesinto the cam tube such that tensioning the flexible member pulls theanvil into the cam tube.
 3. An end effector for use by a surgeon tostaple an anatomical structure of a patient during a minimally invasiveprocedure, the anatomical structure having a first side and a secondside, the end effector comprising: an anvil that includes a first end, asecond end, and a face that is positionable on the first side of theanatomical structure; a cartridge that is configured to house aplurality of staples and that includes a first end, a second end, and aface that is positionable on the second side of the anatomicalstructure; and a flexible member that movably couples the first end ofthe anvil to the first end of the cartridge, wherein the second end ofthe anvil is movably coupled to the second end of the cartridge, each ofthe anvil and the cartridge is insertable through a trocar and the endeffector is remotely operable from outside the patient with at least aportion of one of the anvil and the cartridge being movable toward theother to clamp the end effector to the anatomical structure, wherein atleast one of the first end and the second end of the cartridge includesa cam tube, wherein the anvil includes at least one pin and the cam tubeincludes at least one channel to receive the at least one pin tofacilitate alignment between the anvil and the cartridge when the anvilenters the cam tube.
 4. An end effector for use by a surgeon to staplean anatomical structure of a patient during a minimally invasiveprocedure, the anatomical structure having a first side and a secondside, the end effector comprising: an anvil that includes a first end, asecond end, and a face that is positionable on the first side of theanatomical structure; a cartridge that is configured to house aplurality of staples and that includes a first end, a second end, and aface that is positionable on the second side of the anatomicalstructure; and a flexible member that movably couples the first end ofthe anvil to the first end of the cartridge, wherein the second end ofthe anvil is movably coupled to the second end of the cartridge, each ofthe anvil and the cartridge is insertable through a trocar and the endeffector is remotely operable from outside the patient with at least aportion of one of the anvil and the cartridge being movable toward theother to clamp the end effector to the anatomical structure, wherein atleast one of the first end and the second end of the cartridge includesa cam tube, wherein the anvil includes a lever and the cam tube includesa slot to receive the lever to facilitate alignment between the anviland the cartridge when the anvil enters the cam tube.
 5. An end effectorfor use by a surgeon to staple an anatomical structure of a patientduring a minimally invasive procedure, the anatomical structure having afirst side and a second side, the end effector comprising: an anvil thatincludes a first end, a second end, and a face that is positionable onthe first side of the anatomical structure; a cartridge that isconfigured to house a plurality of staples and that includes a firstend, a second end, and a face that is positionable on the second side ofthe anatomical structure; and a flexible member that movably couples thefirst end of the anvil to the first end of the cartridge, wherein thesecond end of the anvil is movably coupled to the second end of thecartridge, each of the anvil and the cartridge is insertable through atrocar and the end effector is remotely operable from outside thepatient with at least a portion of one of the anvil and the cartridgebeing movable toward the other to clamp the end effector to theanatomical structure, wherein at least one of the first end and thesecond end of the cartridge includes a cam tube, further including ascrew, wherein the cam tube is operably coupled to the screw androtating the screw moves the cam tube along a longitudinal axis of thecartridge.
 6. The end effector of claim 5, wherein, when the cam tubemoves along a longitudinal axis of the cartridge, a gap between theanvil and the cartridge changes.
 7. An end effector for use by a surgeonto staple an anatomical structure of a patient during a minimallyinvasive procedure, the anatomical structure having a first side and asecond side, the end effector comprising: an anvil that includes a firstend, a second end, and a face that is positionable on the first side ofthe anatomical structure; a cartridge that is configured to house aplurality of staples and that includes a first end, a second end, and aface that is positionable on the second side of the anatomicalstructure; and a flexible member that movably couples the first end ofthe anvil to the first end of the cartridge; wherein the anvil and thecartridge slidably receive the flexible member; wherein the second endof the anvil is movably coupled to the second end of the cartridge, eachof the anvil and the cartridge is insertable through a trocar and theend effector is remotely operable from outside the patient with at leasta portion of one of the anvil and the cartridge being movable toward theother to clamp the end effector to the anatomical structure, a strutmechanism that slidably cooperates with the flexible member and thatincludes a strut member that is coupled to one of the anvil and thecartridge between the first end and the second end thereof and ispivotal with respect thereto between a disengaged position in which thestrut member is substantially parallel with the anvil and the cartridgeand an engaged position in which the strut member extends transverselyto the anvil and the cartridge.
 8. The end effector of claim 7, whereina hinge pivotally couples the second end of the anvil to the second endof the cartridge, wherein one of the anvil and the cartridge furtherincludes a stud at the first end, the flexible member being configuredto couple to the stud.
 9. An end effector for use by a surgeon to staplean anatomical structure of a patient during a minimally invasiveprocedure, the anatomical structure having a first side and a secondside, the end effector comprising: an anvil that includes a first end, asecond end, and a face that is positionable on the first side of theanatomical structure; a cartridge that is configured to house aplurality of staples and that includes a first end, a second end, and aface that is positionable on the second side of the anatomicalstructure; and a flexible member that movably couples the first end ofthe anvil to the first end of the cartridge, wherein the second end ofthe anvil is movably coupled to the second end of the cartridge, each ofthe anvil and the cartridge is insertable through a trocar and the endeffector is remotely operable from outside the patient with at least aportion of one of the anvil and the cartridge being movable toward theother to clamp the end effector to the anatomical structure, wherein oneof the anvil and the cartridge includes at least one alignment pinextending outwardly from the face thereof and the other of the anvil andthe cartridge includes a mating recess configured to receive thealignment pin as the anvil and cartridge are moved toward one another,wherein the flexible member extends through the mating recess and iscoupled to the alignment pin such that retraction of the flexible membermoves the alignment pin into the recess.
 10. An end effector for use bya surgeon to staple an anatomical structure of a patient during aminimally invasive procedure, the anatomical structure having a firstside and a second side, the end effector comprising: an anvil thatincludes a first end, a second end, and a face that is positionable onthe first side of the anatomical structure; a cartridge that isconfigured to house a plurality of staples and that includes a firstend, a second end, and a face that is positionable on the second side ofthe anatomical structure; and a flexible member that movably couples thefirst end of the anvil to the first end of the cartridge, wherein thesecond end of the anvil is movably coupled to the second end of thecartridge, each of the anvil and the cartridge is insertable through atrocar and the end effector is remotely operable from outside thepatient with at least a portion of one of the anvil and the cartridgebeing movable toward the other to clamp the end effector to theanatomical structure, further comprising a compression mechanism thatoperably couples the anvil to the cartridge, is separate from theflexible member, and is configured to apply compressive force to theanatomical structure, wherein the compression mechanism includes a wedgethat extends from the anvil and a collar that is engageable with thewedge and is movable relative to the cartridge, wherein the compressionmechanism is engageable when the wedge is positioned to engage thecollar, and when the collar is moved relative to the cartridge, thewedge engages the collar to compress the anatomical structure separatefrom the flexible member.
 11. The end effector of claim 10, wherein thecompression mechanism further includes a second wedge that extends fromthe anvil and a cam tube that is engageable with the second wedge and ismovable relative to the cartridge, wherein the compression mechanism isengageable when the second wedge is positioned to engage the cam tube,and when the cam tube is moved relative to the cartridge, the wedgeengages the cam tube to compress the anatomical structure separate fromthe flexible member.
 12. An end effector for use by a surgeon to staplean anatomical structure of a patient during a minimally invasiveprocedure, the anatomical structure having a first side and a secondside, the end effector comprising: an anvil that includes a first end, asecond end, and a face that is positionable on the first side of theanatomical structure; a cartridge that is configured to house aplurality of staples and that includes a first end, a second end, and aface that is positionable on the second side of the anatomicalstructure; and a flexible member that movably couples the first end ofthe anvil to the first end of the cartridge, wherein the second end ofthe anvil is movably coupled to the second end of the cartridge, each ofthe anvil and the cartridge is insertable through a trocar and the endeffector is remotely operable from outside the patient with at least aportion of one of the anvil and the cartridge being movable toward theother to clamp the end effector to the anatomical structure, wherein theend effector includes an alignment mechanism configured to facilitatealignment between the anvil and the cartridge as the anvil is movedtoward the cartridge, wherein the alignment mechanism includes: a knifethat has a first flange, a second flange, and a web connecting the firstand second flanges and includes a cutting edge; a housing that extendsfrom the cartridge adjacent the first end, the knife residing in thehousing when the anvil and the cartridge are moved toward one another; arecess in the anvil that is adjacent the first end of the end effector,the recess receiving the housing; a first slot in the anvil that is opento the anvil face and to the recess and that is configured to slidablyreceive the web during cutting of the anatomical structure with thecutting edge; and a second slot in the cartridge that is open to thecartridge face and that is configured to slidably receive the web duringcutting of the anatomical structure with the cutting edge.
 13. An endeffector for use by a surgeon to staple an anatomical structure of apatient during a minimally invasive procedure, the anatomical structurehaving a first side and a second side, the end effector comprising: ananvil that includes a first end, a second end, and a face that ispositionable on the first side of the anatomical structure; a cartridgethat is configured to house a plurality of staples and that includes afirst end, a second end, and a face that is positionable on the secondside of the anatomical structure; and a flexible member that movablycouples the first end of the anvil to the first end of the cartridge; asecond flexible member that movably couples the second end of the anvilto the second end of the cartridge; wherein the second end of the anvilis movably coupled to the second end of the cartridge, each of the anviland the cartridge is insertable through a trocar and the end effector isremotely operable from outside the patient with at least a portion ofone of the anvil and the cartridge being movable toward the other toclamp the end effector to the anatomical structure, wherein the firstand second flexible members are independently operable such that a gapbetween the first ends of the anvil and the cartridge is capable ofbeing different from a gap between the second ends of the anvil and thecartridge.
 14. An end effector for use by a surgeon to staple ananatomical structure of a patient during a minimally invasive procedure,the anatomical structure having a first side and a second side, the endeffector comprising: an anvil that includes a first end, a second end,and a face that is positionable on the first side of the anatomicalstructure; a cartridge that is configured to house a plurality ofstaples and that includes a first end, a second end, and a face that ispositionable on the second side of the anatomical structure; and aflexible member that movably couples the first end of the anvil to thefirst end of the cartridge, wherein the second end of the anvil ismovably coupled to the second end of the cartridge, each of the anviland the cartridge is insertable through a trocar and the end effector isremotely operable from outside the patient with at least a portion ofone of the anvil and the cartridge being movable toward the other toclamp the end effector to the anatomical structure; wherein the anviland the cartridge are coupled by a latch at the second end; wherein thelatch is a projection from one of the anvil and the cartridge andincludes a notch and the other of the anvil and the cartridge includes arecess configured to receive the latch, a pin for engaging the notch,and a spring for biasing the pin into engagement with the notch; furtherincluding a release cable coupled to the pin and operable to release thepin from the notch.
 15. A stapling device for use by a surgeon to staplean anatomical structure of a patient during a minimally invasivesurgical procedure, the anatomical structure having a first side and asecond side, the stapling device comprising: an anvil that includes afirst end, a second end, and a face that is positionable on the firstside of the anatomical structure; a cartridge that is configured tohouse a plurality of staples and that includes a first end, a secondend, and a face that is positionable on the second side of theanatomical structure; and a flexible member that movably couples thefirst end of the anvil to the first end of the cartridge; wherein thesecond end of the anvil is movably coupled to the second end of thecartridge, each of the anvil and the cartridge is insertable through atrocar and the end effector is remotely operable from outside thepatient with at least a portion of one of the anvil and the cartridgebeing movable toward the other to clamp the end effector to theanatomical structure, a manipulator that is configured to be accessibleto the surgeon outside of the patient and that includes a shaft coupledto the end effector and a clamping mechanism for selectively moving theanvil and the cartridge toward one another to clamp the anatomicalstructure; and wherein the flexible member extends through the shaft tothe end effector and to the clamping mechanism such that operating theclamping mechanism withdraws the flexible member from the end effectorand clamps the anatomical structure between the anvil and the cartridge.16. The device of claim 15, wherein the clamping mechanism is capable ofselectively tensioning the flexible member to clamp the anvil and thecartridge to the anatomical structure with a first stage clamping forcethat permits the end effector to be repositioned relative to theanatomical structure.
 17. The device of claim 16, wherein the firststage clamping force is between about 0.1 g/mm² and about 4 g/mm². 18.The device of claim 16, wherein the clamping mechanism is capable ofselectively tensioning the flexible member to clamp the anvil and thecartridge to the anatomical structure with a second stage clamping forcethat substantially prevents the end effector from moving relative to theanatomical structure during the medical procedure.
 19. The device ofclaim 18, wherein the second stage clamping force is between about 4g/mm² and about 70 g/mm².
 20. The device of claim 15, wherein themanipulator includes a handpiece that at least partially houses theclamping mechanism, the clamping mechanism further includes a lever thatis pivotable relative to the handpiece and is operable to activate theclamping mechanism.
 21. The device of claim 15, wherein the clampingmechanism includes: a first push bar that is pivotably coupled to thelever; a second push bar that is pivotably coupled to the first pushbar; and a pin that is coupled to the second push bar, the flexiblemember extending around the pin, wherein rotation of the lever relativeto the handpiece moves the pin and withdraws the flexible member fromthe end effector.
 22. The device of claim 15, wherein the clampingmechanism includes: a hub that is pivotable relative to the handpiecewith the lever extending from the hub; a torque arm that extendsoutwardly from the hub; a push bar that is pivotably coupled to thetorque arm at a first end; a clamping rod that is pivotably coupled tothe push bar at a second end and is slidably engaged with the handpiece;and two or more additional rods that are fixed in relation to theclamping rod with the clamping rod between at least two additional rods,wherein the flexible member is in contact with the clamping rod and withtwo of the additional rods such that, when the clamping mechanism isengaged, the clamping rod slides relative to the at least two additionalrods and withdraws the flexible member from the end effector.
 23. Thedevice of claim 22, wherein the manipulator further includes a lockingmechanism for selectively locking the clamping mechanism in an engagedposition in which the anvil and the cartridge clamp the anatomicalstructure.
 24. The device of claim 23, wherein the locking mechanismincludes: a locking arm that extends from the hub; a release lever thatis pivotably coupled relative to and that projects from the handpiece;and a locking finger that extends from the release lever and is biasedinto engagement with the locking arm, wherein rotation of the lever toengage the clamping mechanism engages the locking arm with the lockingfinger.
 25. The device of claim 15, wherein the manipulator includes astapling mechanism that has an actuator coupled to an actuator platethat is slidable relative to the end effector and at least one wedgecoupled to the actuator plate, wherein activating the actuator slidesthe actuator plate and the at least one wedge in the direction of theend effector to force the wedge into engagement with staples.
 26. Thedevice of claim 25, wherein the actuator is a thumb plate.
 27. Thedevice of claim 25, wherein the actuator is a lever and the staplingmechanism further includes a chain consisting of a plurality of linkscoupled to the actuator plate, the lever being operably coupled to thechain such that rotation of the lever moves the chain and the actuatorplate.
 28. The device of claim 25, wherein the manipulator furtherincludes a cutting mechanism having a knife push bar that is slidablycoupled to the actuator plate and a cutting edge at one end of the knifepush bar, wherein, when the stapling mechanism is engaged, the actuatorplate slides relative to the knife push bar for a predetermined distanceduring which the knife push bar is substantially stationary and afterwhich the actuator plate engages the knife push bar.
 29. The device ofclaim 28, wherein the wedge is engaged over the predetermined distance.30. The device of claim 25, wherein the manipulator includes a cuttingmechanism that is configured to cut the anatomical structure and iscoupled to the actuator plate and, when the actuator is engaged, thestapling mechanism begins stapling the anatomical structure prior to thecutting mechanism cutting the anatomical structure.
 31. The device ofclaim 15, wherein the end effector is pivotable relative to the shaft.32. The device of claim 31, wherein the end effector further includes anarticulation mechanism that includes a clevis and a rotation collar, therotation collar frictionally coupling the end effector to the clevis.33. The device of claim 32, further comprising: a compression mechanismthat operably couples the anvil to the cartridge, that is separate fromthe flexible member, and that is configured to apply compressive forceto the anatomical structure, the compression mechanism including a hookmember that extends from the anvil, a pin that is engageable with thehook member, and a compression slide that carries the pin and isselectively slidable relative to the cartridge, wherein the compressionmechanism is engageable when the hook member is positioned to engage thepin and, when the compression slide is forcibly moved relative to thecartridge, the pin engages the hook member to compress the anatomicalstructure separate from the flexible member.
 34. The device of claim 32,further comprising: a compression mechanism that operably couples theanvil to the cartridge, that is separate from the flexible member, andthat is configured to apply compressive force to the anatomicalstructure, the compression mechanism including a wedge that extends fromthe anvil and a collar that is engageable with the wedge and is movablerelative to the cartridge, wherein the compression mechanism isengageable when the wedge is positioned to engage the collar, and whenthe collar is moved relative to the cartridge, the wedge engages thecollar to compress the anatomical structure separate from the flexiblemember.
 35. An end effector coupled to a manipulator having a shaft, theend effector being for use by a surgeon to staple an anatomicalstructure of a patient during a minimally invasive procedure, theanatomical structure having a first side and a second side, the endeffector comprising: an anvil that includes a first end, a second end,and a face that is positionable on the first side of the anatomicalstructure; a cartridge that is configured to house a plurality ofstaples and that includes a first end, a second end, and a face that ispositionable on the second side of the anatomical structure; a housingthat extends from one end of the anvil or the cartridge, that includes aflange, that defines a longitudinal axis; a clevis that is coupled tothe shaft and operable to pivot relative to the shaft; and a rotationcollar that is rotatably coupled to the flange and is coupled to theclevis, the flange being capable of rotating within the rotation collar,wherein each of the anvil, the cartridge, the housing, the clevis, andthe rotation collar is insertable through a trocar, the end effector isrotatable about the longitudinal axis, is pivotable relative to theshaft at the clevis, and is remotely operable from outside the patientwith at least a portion of one of the anvil and the cartridge beingmovable toward the other to clamp the end effector to the anatomicalstructure.
 36. The end effector of claim 35, wherein the first end ofthe cartridge is movably coupled to the first end of the anvil and thesecond end of the cartridge is movably coupled to the second end of theanvil.
 37. The end effector of claim 35, wherein the first end of theanvil is configured to extend beyond one of a proximal end or a distalend of the anatomical structure, the second end of the anvil isconfigured to extend beyond the other of the proximal end or the distalend of the anatomical structure, the first end of the cartridge isconfigured to extend beyond one of the proximal end or the distal end ofthe anatomical structure, and the second end of the cartridge isconfigured to extend beyond the other of the proximal end or the distalend of the anatomical structure.
 38. The end effector of claim 35,further comprising: a flexible member that movably couples the first endof the anvil to the first end of the cartridge.
 39. The end effector ofclaim 38, wherein the flexible member movably couples the second end ofthe anvil to the second end of the cartridge.
 40. The end effector ofclaim 38, wherein at least one of the anvil and the cartridge slidablyreceives the flexible member when the end effector is clamped onto theanatomical structure.
 41. The end effector of claim 38, wherein theanvil and the cartridge slidably receive the flexible member.
 42. Theend effector of claim 38, wherein the flexible member is anchored to theanvil.
 43. The end effector of claim 38, wherein the flexible member isanchored to the cartridge.
 44. The end effector of claim 38, furthercomprising: a tensioning device operable by the surgeon for selectivelytensioning the flexible member to provide at least a portion of theclamping force on the anatomical structure.
 45. The end effector ofclaim 44, wherein the tensioning device includes a spring operablycoupled to the flexible member.
 46. The end effector of claim 38,wherein at least one of the first end and the second end of thecartridge includes a cam tube.
 47. The end effector of claim 46, whereinthe flexible member passes into the cam tube such that tensioning theflexible member pulls the anvil into the cam tube.
 48. The end effectorof claim 46, wherein the cam tube includes a first arcuate surface andthe anvil includes a second arcuate surface that is configured tocooperate with the first arcuate surface.
 49. The end effector of claim46, wherein the anvil includes at least one pin and the cam tubeincludes at least one channel to receive the at least one pin tofacilitate alignment between the anvil and the cartridge when the anvilenters the cam tube.
 50. The end effector of claim 46, wherein the anvilincludes a lever and the cam tube includes a slot to receive the leverto facilitate alignment between the anvil and the cartridge when theanvil enters the cam tube.
 51. The end effector of claim 46, wherein thecam tube is slidable along an axis that is generally parallel to thelongitudinal axis of the cartridge.
 52. The end effector of claim 46,wherein the cam tube includes a wedge-shaped surface and the anvilincludes a tapered surface on one end thereof that engages thewedge-shaped surface when the anvil enters the cam tube.
 53. The endeffector of claim 46, further including a screw, wherein the cam tube isoperably coupled to the screw and rotating the screw moves the cam tubealong a longitudinal axis of the cartridge.
 54. The end effector ofclaim 53, wherein, when the cam tube moves along a longitudinal axis ofthe cartridge, a gap between the anvil and the cartridge changes. 55.The end effector of claim 38, wherein one of the anvil and the cartridgefurther includes a retraction tab coupled to an end of the flexiblemember.
 56. The end effector of claim 38, wherein the flexible memberextends in a non-linear path from proximate the first end to proximatethe second end of one of the anvil and the cartridge.
 57. The endeffector of claim 38, further comprising: a strut mechanism thatslidably cooperates with the flexible member and that includes a strutmember that is coupled to one of the anvil and the cartridge between thefirst end and the second end thereof and is pivotal with respect theretobetween a disengaged position in which the strut member is substantiallyparallel with the anvil and the cartridge and an engaged position inwhich the strut member extends transversely to the anvil and thecartridge.
 58. The end effector of claim 38, further comprising anadjustment mechanism coupled to the flexible member that adjusts a gapbetween the anvil and the cartridge.
 59. The end effector of claim 58,wherein the adjustment mechanism includes a knob and a spring in linewith at least one end of the flexible member.
 60. The end effector ofclaim 38, wherein one of the anvil and the cartridge includes at leastone alignment pin extending outwardly from the face thereof and theother of the anvil and the cartridge includes a mating recess configuredto receive the alignment pin as the anvil and cartridge are moved towardone another.
 61. The end effector of claim 60, wherein the flexiblemember extends through the mating recess and is coupled to the alignmentpin such that retraction of each flexible member moves the alignment pininto the recess.
 62. The end effector of claim 38, further comprising: acompression mechanism that operably couples the anvil to the cartridge,that is separate from the flexible member, and that is configured toapply compressive force to the anatomical structure.
 63. The endeffector of claim 62, wherein the compression mechanism includes a hookmember that extends from the anvil, a pin that is engageable with thehook member, and a compression slide that carries the pin and isselectively slidable relative to the cartridge, wherein the compressionmechanism is engageable when the hook member is positioned to engage thepin and, when the compression slide is forcibly moved relative to thecartridge, the pin engages the hook member to compress the anatomicalstructure separate from the flexible member.
 64. The end effector ofclaim 62, wherein the compression mechanism includes a wedge thatextends from the anvil and a collar that is engageable with the wedgeand is movable relative to the cartridge, wherein the compressionmechanism is engageable when the wedge is positioned to engage thecollar, and when the collar is moved relative to the cartridge, thewedge engages the collar to compress the anatomical structure separatefrom the flexible member.
 65. The end effector of claim 62, wherein thecompression mechanism further includes a second wedge that extends fromthe anvil and a cam tube that is engageable with the second wedge and ismovable relative to the cartridge, wherein the compression mechanism isengageable when the second wedge is positioned to engage the cam tube,and when the cam tube is moved relative to the cartridge, the wedgeengages the cam tube to compress the anatomical structure separate fromthe flexible member.
 66. The end effector of claim 35, wherein at leastone of the first end and the second end of the cartridge includes a camtube.
 67. The end effector of claim 66, wherein the first end of thecartridge includes a first cam tube and the second end of the cartridgeincludes a second cam tube.
 68. The end effector of claim 67, whereinthe first and second cam tubes are configured to move along alongitudinal axis of the cartridge, and when at least one of the firstand second cam tubes moves, a gap between the anvil and the cartridgechanges.
 69. The end effector of claim 35, wherein the end effectorincludes an alignment mechanism configured to facilitate alignmentbetween the anvil and the cartridge as the anvil is moved toward thecartridge.
 70. The end effector of claim 69, wherein the alignmentmechanism includes a pin on one of the anvil and the cartridge and arecess on the other of the anvil and the cartridge.
 71. The end effectorof claim 69, wherein the alignment mechanism includes: a knife that hasa first flange, a second flange, and a web connecting the first andsecond flanges and includes a cutting edge; a housing that extends fromthe cartridge adjacent the first end, the knife residing in the housingwhen the anvil and the cartridge are moved toward one another; a recessin the anvil that is adjacent the first end of the end effector, therecess receiving the housing; a first slot in the anvil that is open tothe anvil face and to the recess and that is configured to slidablyreceive the web during cutting of the anatomical structure with thecutting edge; and a second slot in the cartridge that is open to thecartridge face and that is configured to slidably receive the web duringcutting of the anatomical structure with the cutting edge.
 72. The endeffector of claim 35, wherein each of the first ends and the second endsof the anvil and the cartridge are coupled together by a hinge joint, aflexible member, a latch, or combinations thereof.
 73. The end effectorof claim 35, wherein a hinge pivotally couples the first end of theanvil to the first end of the cartridge and a flexible member movablycouples the second end of the anvil to the second end of the cartridge.74. The end effector of claim 73, further including a spring operablycoupled to each of the anvil and the cartridge biasing the anvil and thecartridge away from each other.
 75. The end effector of claim 73,wherein one of the anvil and the cartridge further includes a stud atthe second end, the flexible member configured to couple to the stud.76. The end effector of claim 35, wherein the anvil and the cartridgeare coupled by a snap fit connection at the first end.
 77. The endeffector of claim 35, wherein one of the anvil and the cartridgeincludes a hook on the first end, the other of the anvil and thecartridge includes a lever at the first end, and the hook is configuredto engage the lever to couple the anvil and the cartridge at the firstend.
 78. The end effector of claim 35, further comprising: a firstflexible member that movably couples the first end of the anvil to thefirst end of the cartridge, and a second flexible member that movablycouples the second end of the anvil to the second end of the cartridge.79. The end effector of claim 78, wherein the first and second flexiblemembers are independently operable such that a gap between the firstends of the anvil and the cartridge is capable of being different from agap between the second ends of the anvil and the cartridge.
 80. The endeffector of claim 35, wherein the anvil and the cartridge are coupled bya latch at one of the first and second ends and a flexible member at theother of the first and second ends.
 81. The end effector of claim 80,wherein the latch is a projection from one of the anvil and thecartridge and includes a notch and the other of the anvil and thecartridge includes a recess configured to receive the latch, a pin forengaging the notch, and a spring for biasing the pin into engagementwith the notch.
 82. The end effector of claim 81, further including arelease cable coupled to the pin and operable to release the pin fromthe notch.
 83. The end effector of claim 35, wherein the anvil and thecartridge are curved.
 84. The end effector of claim 35, wherein the endeffector is insertable through a trocar.
 85. The end effector of claim35, wherein the second end of the anvil is coupled to the second end ofthe cartridge by a hinge joint, a flexible member, a latch, or acombination thereof.
 86. A stapling device for use by a surgeon tostaple an anatomical structure of a patient during a minimally invasivesurgical procedure, the anatomical structure having a first side and asecond side, the stapling device comprising: the end effector of claim35; a manipulator that is configured to be accessible to the surgeonoutside of the patient and that includes a shaft coupled to the endeffector and a clamping mechanism for selectively moving the anvil andthe cartridge toward one another to clamp the anatomical structure; anda flexible member that extends through the shaft to the end effector andis operably coupled to at least one of the anvil and the cartridge andto the clamping mechanism such that operating the clamping mechanismwithdraws the flexible member from the end effector and clamps theanatomical structure between the anvil and the cartridge.
 87. The deviceof claim 86, wherein the clamping mechanism is capable of selectivelytensioning the flexible member to clamp the anvil and the cartridge tothe anatomical structure with a first stage clamping force that permitsthe end effector to be repositioned relative to the anatomicalstructure.
 88. The device of claim 87, wherein the first stage clampingforce is between about 0.1 g/mm² and about 4 g/mm².
 89. The device ofclaim 87, wherein the clamping mechanism is capable of selectivelytensioning the flexible member to clamp the anvil and the cartridge tothe anatomical structure with a second stage clamping force thatsubstantially prevents the end effector from moving relative to theanatomical structure during the medical procedure.
 90. The device ofclaim 89, wherein the second stage clamping force is between about 4g/mm² and about 70 g/mm².
 91. The device of claim 86, wherein themanipulator includes a handpiece that at least partially houses theclamping mechanism, the clamping mechanism further includes a lever thatis pivotable relative to the handpiece and is operable to activate theclamping mechanism.
 92. The device of claim 91, wherein the clampingmechanism includes: a first push bar that is pivotably coupled to thelever; a second push bar that is pivotably coupled to the first pushbar; and a pin that is coupled to the second push bar, the flexiblemember extending around the pin, wherein rotation of the lever relativeto the handpiece moves the pin and withdraws the flexible member fromthe end effector.
 93. The device of claim 91, wherein the clampingmechanism includes: a hub that is pivotable relative to the handpiecewith the lever extending from the hub; a torque arm that extendsoutwardly from the hub; a push bar that is pivotably coupled to thetorque arm at a first end; a clamping rod that is pivotably coupled tothe push bar at a second end and is slidably engaged with the handpiece;and two or more additional rods that are fixed in relation to theclamping rod with the clamping rod between at least two additional rods,wherein the flexible member is in contact with the clamping rod and withtwo of the additional rods such that, when the clamping mechanism isengaged, the clamping rod slides relative to the at least two additionalrods and withdraws the flexible member from the end effector.
 94. Thedevice of claim 86, wherein the manipulator further includes a lockingmechanism for selectively locking the clamping mechanism in an engagedposition in which the anvil and the cartridge clamp the anatomicalstructure.
 95. The device of claim 94, wherein the locking mechanismincludes: a locking arm that extends from the hub; a release lever thatis pivotably coupled relative to and that projects from the handpiece;and a locking finger that extends from the release lever and is biasedinto engagement with the locking arm, wherein rotation of the lever toengage the clamping mechanism engages the locking arm with the lockingfinger.
 96. The device of claim 86, wherein the manipulator includes astapling mechanism that has an actuator coupled to an actuator platethat is slidable relative to the end effector and at least one wedgecoupled to the actuator plate, wherein activating the actuator slidesthe actuator plate and the at least one wedge in the direction of theend effector to force the wedge into engagement with staples.
 97. Thedevice of claim 96, wherein the actuator is a thumb plate.
 98. Thedevice of claim 96, wherein the actuator is a lever and the staplingmechanism further includes a chain consisting of a plurality of linkscoupled to the actuator plate, the lever being operably coupled to thechain such that rotation of the lever moves the chain and the actuatorplate.
 99. The device of claim 86, wherein the manipulator furtherincludes a cutting mechanism having a knife push bar that is slidablycoupled to the actuator plate and a cutting edge at one end of the knifepush bar, wherein, when the stapling mechanism is engaged, the actuatorplate slides relative to the knife push bar for a predetermined distanceduring which the knife push bar is substantially stationary and afterwhich the actuator plate engages the knife push bar.
 100. The device ofclaim 99, wherein the wedge is engaged over the predetermined distance.101. The device of claim 86, wherein the manipulator includes a cuttingmechanism that is configured to cut the anatomical structure and iscoupled to the actuator plate and, when the actuator is engaged, thestapling mechanism begins stapling the anatomical structure prior to thecutting mechanism cutting the anatomical structure.
 102. The device ofclaim 86, wherein the end effector is pivotable relative to the shaft.103. The device of claim 102, wherein the end effector further includesan articulation mechanism that includes a clevis and a rotation collar,the rotation collar frictionally coupling the end effector to theclevis.
 104. The device of claim 103, further comprising: a compressionmechanism that operably couples the anvil to the cartridge, that isseparate from the flexible member, and that is configured to applycompressive force to the anatomical structure, the compression mechanismincluding a hook member that extends from the anvil, a pin that isengageable with the hook member, and a compression slide that carriesthe pin and is selectively slidable relative to the cartridge, whereinthe compression mechanism is engageable when the hook member ispositioned to engage the pin and, when the compression slide is forciblymoved relative to the cartridge, the pin engages the hook member tocompress the anatomical structure separate from the flexible member.105. The device of claim 103, further comprising: a compressionmechanism that operably couples the anvil to the cartridge, that isseparate from the flexible member, and that is configured to applycompressive force to the anatomical structure, the compression mechanismincluding a wedge that extends from the anvil and a collar that isengageable with the wedge and is movable relative to the cartridge,wherein the compression mechanism is engageable when the wedge ispositioned to engage the collar, and when the collar is moved relativeto the cartridge, the wedge engages the collar to compress theanatomical structure separate from the flexible member.
 106. An endeffector for use by a surgeon to staple an anatomical structure of apatient during a minimally invasive procedure, the anatomical structurehaving a first side and a second side, the end effector comprising: ananvil that includes a first end, a second end, and a face that ispositionable on the first side of the anatomical structure; a cartridgethat is configured to house a plurality of staples and that includes afirst end, a second end, and a face that is positionable on the secondside of the anatomical structure, the first end of the cartridge isseparably coupled to the first end of the anvil and the second end ofthe cartridge is separably coupled to the second end of the anvil; andwherein each of the anvil and the cartridge is insertable through atrocar and the end effector is remotely operable from outside thepatient with at least a portion of one of the anvil and the cartridgebeing movable toward the other to clamp the end effector to theanatomical structure, wherein the first end of the cartridge includes afirst cam tube and the second end of the cartridge includes a second camtube.
 107. The end effector of claim 106, wherein the first and secondcam tubes are configured to move along a longitudinal axis of thecartridge, and when at least one of the first and second cam tubesmoves, a gap between the anvil and the cartridge changes.
 108. The endeffector of claim 106, wherein the first and second cam tubes areconfigured to move along a longitudinal axis of the cartridge, and whenat least one of the first and second cam tubes moves, a gap between theanvil and the cartridge changes.